Keywords
Inter-hospital transfer
National Inpatient Sample
Health services research
Biliary disease
How to Cite
Abstract
Background: Inter-hospital transfer is frequently used to facilitate access to advanced biliary intervention and higher-level care for patients with acute cholangitis. However, its association with inpatient outcomes remains incompletely defined. We evaluated the relationship between transfer-in status and clinical outcomes among adults hospitalized with acute cholangitis.
Methods: We performed a retrospective hospitalization-level analysis using the National Inpatient Sample. Adult hospitalizations with acute cholangitis were identified using ICD-10-CM codes and stratified by interhospital transfer status. Survey-weighted analyses compared patient characteristics, outcomes, and resource utilization. Multivariable survey-weighted logistic regression assessed the adjusted association between transfer-in status and adverse outcomes.
Results: An estimated 36,125 acute cholangitis hospitalizations were identified nationally; 16.8% involved inter-hospital transfer. Transferred hospitalizations were more often among White patients, patients from lower-income ZIP codes, and those treated at large urban teaching hospitals. Transferred patients had higher unadjusted rates of shock, acute respiratory failure, mechanical ventilation, dialysis, and in-hospital mortality (5.8% vs 4.5%; P = 0.047). After adjustment, transfer-in status was not significantly associated with in-hospital mortality (adjusted odds ratio [aOR], 1.26; 95% CI, 0.95–1.68; P = 0.106), but was associated with acute respiratory failure (aOR, 1.30; 95% CI, 1.06–1.58; P = 0.011), mechanical ventilation (aOR, 1.64; 95% CI, 1.28–2.10; P < 0.001), and dialysis (aOR, 1.39; 95% CI, 1.01–1.92; P = 0.045).
Conclusions: Transfer-in status was not significantly associated with adjusted in-hospital mortality, but it was associated with markers of greater illness severity and resource utilization. Findings should be interpreted within the limitations of administrative hospitalization data.
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Copyright (c) 2026 Muhammad Haris Latif, Imran Khokhar, Ayesha Kang, Eman Mazhar, Kahee A. Mohammed, Joel Riley, Hani El Halawany , Kamran Qureshi