Time Is of the Essence: Impact of Transfer on Outcomes in Acute Mesenteric Ischemia

BACKGROUND: Acute mesenteric ischemia (AMI) is a vascular emergency where delays in diagnosis or treatment can lead to irreversible bowel injury and death. Many patients initially present to hospitals without surgical or vascular capabilities and require interhospital transfer. The clinical impact of such transfers on treatment and outcomes in AMI remains poorly defined. STUDY DESIGN: We performed a retrospective cohort study using the National Inpatient Sample (2019 to 2021) to evaluate the association between interhospital transfer and outcomes in patients with AMI. Adult patients with a primary diagnosis of AMI were identified using ICD-10 codes. Patients were categorized by transfer status. Multivariable logistic regression was used to evaluate associations with in-hospital mortality and procedural interventions, adjusting for age and comorbidity burden. RESULTS: Of 39,690 hospitalizations for AMI, 14.6% involved interhospital transfer. Transferred patients had a higher comorbidity burden and were more often treated at rural or micropolitan hospitals. They were significantly more likely to undergo major surgical and vascular procedures, including bowel resection (odds ratio [OR] 3.48), mesenteric bypass (OR 3.32), and angioplasty (OR 2.66; all p < 0.0001). Markers of critical illness, such as intubation (OR 2.15) and dialysis (OR 1.30), were also more frequent in this group. In-hospital mortality was significantly higher among transferred patients (OR 2.05), and transfer remained independently associated with increased mortality after adjusting for age and comorbidity burden (adjusted OR 1.67, 95% CI 1.32 to 2.10). CONCLUSIONS: Interhospital transfer in AMI is strongly associated with increased clinical severity and in-hospital mortality. These findings emphasize the urgency of early diagnosis, rapid triage, and timely access to definitive care, supporting the need for structured regional systems and transfer protocols for AMI.