{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T02:37:35Z","timestamp":1774406255016,"version":"3.50.1"},"reference-count":36,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T00:00:00Z","timestamp":1752278400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: This study investigated the reasons for transferring patients to tertiary hospitals due to complications arising after surgery at orthopedic specialty hospitals and the treatment results. Methods: This retrospective cohort study was conducted on all orthopedic patients, except for the spine, at a single institution from January 2012 to May 2022. Results: Of 67,118 patients, 167 (0.24%) were transferred to a tertiary hospital after surgery. Patients\u2019 average age was 72.2 \u00b1 9.2 years (range: 28\u201391 years), and there were 34 men and 133 women. The most common reason for transfer to a tertiary hospital was pulmonary embolism (27 patients, 16.2%), which occurred on an average 3.81 days (range: 0\u201323 days) after surgery, and 25 patients were transferred within 1 week after surgery. The next most common cause was acute cholecystitis (19 patients (11.4%), all of whom had undergone total knee arthroplasty), which occurred on an average 6.15 days (range: 1\u201314 days) after surgery. Conclusions: The rate of transfer from the orthopedic hospital where this study was conducted to a tertiary hospital was very low at 0.24%. Pulmonary embolism, acute cholecystitis, and cerebral infarct were the most common reasons for transfer. In particular, acute cholecystitis was the second most common reason for transfer, and caution should be taken because elderly patients may experience only atypical clinical symptoms without abdominal pain or tenderness even the day after surgery.<\/jats:p>","DOI":"10.3390\/jcm14144943","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T10:55:41Z","timestamp":1752490541000},"page":"4943","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Analysis of the Reasons for Transferring Patients from Orthopedic Specialty Hospitals to Tertiary Hospitals After Surgery"],"prefix":"10.3390","volume":"14","author":[{"given":"Juneyoung","family":"Heo","sequence":"first","affiliation":[{"name":"Joint & Arthritis Research, Department of Neurosurgery, Himchan Hospital, Seoul 07999, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su Chan","family":"Lee","sequence":"additional","affiliation":[{"name":"Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8980-9532","authenticated-orcid":false,"given":"Ji Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang Hyun","family":"Nam","sequence":"additional","affiliation":[{"name":"Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong Nyoung","family":"Lee","sequence":"additional","affiliation":[{"name":"Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji-Hoon","family":"Baek","sequence":"additional","affiliation":[{"name":"Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11420-005-0116-0","article-title":"Hospital for Special Surgery: Origin and early history first site 1863-1870","volume":"1","author":"Levine","year":"2005","journal-title":"HSS J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1177\/1077558708316687","article-title":"The economics of specialty hospitals","volume":"65","author":"Schneider","year":"2008","journal-title":"Med. Care Res. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1377\/hlthaff.22.6.56","article-title":"Focused factories? Physician-owned specialty facilities","volume":"22","author":"Casalino","year":"2003","journal-title":"Health Aff."},{"key":"ref_4","unstructured":"Subcommittee on Federal Financial Management, Government Information, and International Security, Committee on Homeland Security and Governmental Affairs, U.S. Senate (2005). Physician-Owned Specialty Hospitals."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e.20.00093","DOI":"10.2106\/JBJS.RVW.20.00093","article-title":"Orthopaedic Specialty Hospitals Compared with General Hospitals: A Systematic Review of Demographic, Clinical, and Financial Parameters","volume":"9","author":"Leider","year":"2021","journal-title":"JBJS Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e84","DOI":"10.3928\/01477447-20171127-04","article-title":"Short-term Outcomes of Total Knee Arthroplasty Performed at an Orthopedic Specialty Hospital","volume":"41","author":"Padegimas","year":"2018","journal-title":"Orthopedics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1016\/j.arth.2017.03.032","article-title":"Comparison of Short-Term Outcomes After Total Hip Arthroplasty Between an Orthopedic Specialty Hospital and General Hospital","volume":"32","author":"Padegimas","year":"2017","journal-title":"J. Arthroplast."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e006525","DOI":"10.1136\/bmjopen-2014-006525","article-title":"Governmental designation of spine specialty hospitals, their characteristics, performance and designation effects: A longitudinal study in Korea","volume":"4","author":"Kim","year":"2014","journal-title":"BMJ Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"746","DOI":"10.2106\/JBJS.9408.ebo746","article-title":"American Academy of Orthopaedic Surgeons clinical practice guideline on: Preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty","volume":"94","author":"Jacobs","year":"2012","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.3346\/jkms.2010.25.11.1553","article-title":"Korean guidelines for the prevention of venous thromboembolism","volume":"25","author":"Bang","year":"2010","journal-title":"J. Korean Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/ggi.12483","article-title":"Acute cholecystitis in elderly patients after hip fracture: Incidence and epidemiology","volume":"16","author":"Choo","year":"2016","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/00000658-197608000-00004","article-title":"Acute cholecystitis as a postoperative complication","volume":"184","author":"Ottinger","year":"1976","journal-title":"Ann. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.3346\/jkms.2019.34.e36","article-title":"Acute Cholecystitis in Elderly Patients after Hip Fracture: A Nationwide Cohort Study","volume":"34","author":"Jang","year":"2019","journal-title":"J. Korean Med. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Yuan, Y., Tian, W., Jin, Z., Wang, L., and Zhu, S. (2023). Cholecystitis in older patients following hip fracture: A case series and literature review. BMC Geriatr., 23.","DOI":"10.1186\/s12877-023-04336-9"},{"key":"ref_15","first-page":"218","article-title":"Acute abdominal complications following hip surgery","volume":"109","author":"Deleanu","year":"2014","journal-title":"Chirurgia"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1097\/00003086-198804000-00031","article-title":"Hematogenously acquired infection of a total knee arthroplasty by Clostridium perfringens","volume":"229","author":"Wilde","year":"1988","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_17","first-page":"100","article-title":"Acute Cholecystitis Following Total Knee Replacement: A Case Report and Literature Review","volume":"6","author":"Ghalimah","year":"2016","journal-title":"J. Orthop. Case Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/BF02232293","article-title":"Postoperative cholecystitis","volume":"17","author":"Howard","year":"1972","journal-title":"Am. J. Dig. Dis."},{"key":"ref_19","first-page":"648","article-title":"The management of acute cholecystitis in elderly patients","volume":"57","author":"Hafif","year":"1991","journal-title":"Am. Surg."},{"key":"ref_20","first-page":"153","article-title":"Post operative complications in a dedicated elective orthopaedic hospital: Transfers requiring specialist critical care support","volume":"108","author":"Dawson","year":"2015","journal-title":"Ir. Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.arth.2022.01.058","article-title":"Orthopedic Specialty Hospital Reasons for Transfer and Subsequent Outcomes","volume":"37","author":"Blaber","year":"2022","journal-title":"J. Arthroplast."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"562","DOI":"10.2106\/00004623-200204000-00009","article-title":"Rate of and risk factors for acute inpatient mortality after orthopaedic surgery","volume":"84","author":"Bhattacharyya","year":"2002","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"349s","DOI":"10.1378\/chest.124.6_suppl.349S","article-title":"Temporal trends in prevention of venous thromboembolism following primary total hip or knee arthroplasty 1996-2001: Findings from the Hip and Knee Registry","volume":"124","author":"Anderson","year":"2003","journal-title":"Chest"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Santana, D.C., Emara, A.K., Orr, M.N., Klika, A.K., Higuera, C.A., Krebs, V.E., Molloy, R.M., and Piuzzi, N.S. (2020). An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020. Medicina, 56.","DOI":"10.3390\/medicina56090416"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s13018-017-0549-4","article-title":"Incidence of venous thromboembolism and bleeding events in patients with lower extremity orthopedic surgery: A retrospective analysis of a Japanese healthcare database","volume":"12","author":"Fuji","year":"2017","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1302\/0301-620X.94B1.27301","article-title":"Meta-analysis of cause of death following total joint replacement using different thromboprophylaxis regimens","volume":"94","author":"Poultsides","year":"2012","journal-title":"J. Bone Joint Surg. Br."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Li, H., Li, Z., Yang, N., Xing, J., Yuan, H., Song, Z., Wei, X., Ma, T., Wang, Q., and Wang, P. (2025). Perioperative ultrasound screening of lower extremity veins is effective in the prevention of fatal pulmonary embolism in orthopedic patients. Sci. Rep., 15.","DOI":"10.1038\/s41598-024-84572-0"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"28","DOI":"10.3346\/jkms.2010.25.1.28","article-title":"Venous thromboembolism in Korean patients undergoing major orthopedic surgery: A prospective observational study using computed tomographic (CT) pulmonary angiography and indirect CT venography","volume":"25","author":"Cha","year":"2010","journal-title":"J. Korean Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1007\/s00402-008-0751-2","article-title":"Deep vein thrombosis after total hip arthroplasty in Korean patients and D-dimer as a screening tool","volume":"129","author":"Yoo","year":"2009","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3423","DOI":"10.1007\/s11999-011-1979-7","article-title":"Deep venous thrombosis and pulmonary embolism are uncommon in East Asian patients after total hip arthroplasty","volume":"469","author":"Kang","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1007\/s11999-012-2758-9","article-title":"The incidence of pulmonary embolism and deep vein thrombosis after knee arthroplasty in Asians remains low: A meta-analysis","volume":"471","author":"Lee","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.arth.2008.11.010","article-title":"Risk factors for perioperative mortality after lower extremity arthroplasty: A population-based study of 6,901,324 patient discharges","volume":"25","author":"Memtsoudis","year":"2010","journal-title":"J. Arthroplast."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"20","DOI":"10.2106\/JBJS.M.00018","article-title":"Thirty-day postoperative complications and mortality following total knee arthroplasty: Incidence and risk factors among a national sample of 15,321 patients","volume":"96","author":"Belmont","year":"2014","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1016\/j.arth.2013.07.009","article-title":"Transfer of hip arthroplasty patients leads to increased cost and resource utilization in the receiving hospital","volume":"28","author":"Kamath","year":"2013","journal-title":"J. Arthroplast."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Jojczuk, M., Naylor, K., Serwin, A., Dolliver, I., G\u0142uchowski, D., Gajewski, J., Karpi\u0144ski, R., Krakowski, P., Torres, K., and Nogalski, A. (2024). Descriptive Analysis of Trauma Admission Trends before and during the COVID-19 Pandemic. J. Clin. Med., 13.","DOI":"10.3390\/jcm13010259"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Jojczuk, M., Pawlikowski, J., Kami\u0144ski, P., G\u0142uchowski, D., Naylor, K., Gajewski, J., Karpi\u0144ski, R., Krakowski, P., Jonak, J., and Nogalski, A. (2023). Evaluating Changes in Trauma Epidemiology during the COVID-19 Lockdown: Insights and Implications for Public Health and Disaster Preparedness. Healthcare, 11.","DOI":"10.3390\/healthcare11172436"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/4943\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:09:00Z","timestamp":1760033340000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/4943"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,12]]},"references-count":36,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14144943"],"URL":"https:\/\/doi.org\/10.3390\/jcm14144943","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,12]]}}}