Emergency Department Visits After Elective Spine Surgery

Hills, Jeffrey M.; Khan, Inamullah; Sivaganesan, Ahilan; Weisenthal, Benjamin M.; Daryoush, Joshua; Butler, Marjorie; Bydon, Mohamad; Archer, Kristin R.; Asher, Anthony L.; Devin, Clinton J.

doi:10.1093/neuros/nyy445

Cited by 17 publications

(16 citation statements)

References 21 publications

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“… 28 ED presentation and readmission after total knee and total hip arthroplasty have proven to be a high burden to the health care system and have prompted discussion about patient-centered interventions that can safely intervene and prevent those outcomes. 35 Our results suggest that patients with sustained opioid use after surgery require both monitoring and judicious intervention 26 to optimize their safety and lower the risk for ED visits and hospital admissions after index arthroscopy.…”

Section: Discussionmentioning

confidence: 85%

Effect of Perioperative Opioid Use on Patients Undergoing Hip Arthroscopy

Rogers

LaBelle

Kim

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Opioids are commonly used to treat postoperative pain; however, guidelines vary regarding safe opioid use after hip arthroscopy. Purpose/Hypothesis: The purposes were to (1) identify risk factors for persistent opioid use, (2) assess the effect of opioid use on outcomes, and (3) describe common opioid prescribing patterns after hip arthroscopy. It was hypothesized that preoperative opioid use would affect complication rates and result in greater postoperative opioid use. Study Design: Case-control study; Level of evidence 3. Methods: The Utah State All Payer Claims Database was queried for patients who underwent hip arthroscopy between January 2013 and December 2017. Included were patients ≥14 years of age at index surgery with continuous insurance. Patients were separated into acute (<3 months) and chronic (≥3 months) postoperative opioid use groups. Primary outcomes included revision surgery, complications (infection, pulmonary embolism/deep venous thrombosis, death), emergency department (ED) visits, and hospital admissions. Multivariate logistic regression was utilized to identify factors associated with the outcomes. Results: Included were 2835 patients (mean age, 47 years; range, 14-64 years), of whom 2544 were in the acute opioid use and 291 were in the chronic opioid use group. Notably, 91% of the patients in the chronic group took opioid medications preoperatively, and they were more than twice as likely to carry a mental health diagnosis ( P < .01). Patients in the acute group had a significantly shorter initial prescription duration, took fewer opioid pills, and had fewer refills than those in the chronic group ( P < .01 for all). Patients in the chronic group had a significantly higher risk of postoperative ED visits (odds ratio [OR], 2.76; P = .008), hospital admission (OR, 3.02; P = .002), and additional surgery ( P = .003), as well as infection (OR, 2.55; P < .001) and hematoma (OR, 2.43; P = .030). Patients who had used opioids before hip arthroscopy were more likely to need more refills ( P < .01). A formal opioid use disorder diagnosis correlated significantly with postoperative hospital admissions (OR, 3.83; P = .044) and revision hip arthroscopy (OR, 4.72; P = .003). Conclusion: Mental health and substance use disorders were more common in patients with chronic postoperative opioid use, and chronic postoperative opioid use was associated with greater likelihood of postoperative complications. Preoperative opioid use was significantly correlated with chronic postoperative opioid use and with increased refill requests after index arthroscopy.

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Section: Discussionmentioning

confidence: 85%

Effect of Perioperative Opioid Use on Patients Undergoing Hip Arthroscopy

Rogers

LaBelle

Kim

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…Previous studies have demonstrated that postoperative ED visits in this population are typically related to pain and medical concerns. 27 Since many ED visits are avoidable following spine surgery, 28 interventions aimed at decreasing unnecessary ED visits may help reduce the overall cost of postoperative care for patients following ACDF. Apart from readmissions, the 3 largest contributors to postoperative spending were imaging, physical therapy, and medical supplies/devices (13.7% to 14.3%).…”

Section: Discussionmentioning

confidence: 99%

Health Care Resource Utilization in Commercially Insured Patients Undergoing Anterior Cervical Discectomy and Fusion for Degenerative Cervical Pathology

Marrache

Harris

Puvanesarajah

et al. 2020

Global Spine Journal

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Study Design: Retrospective review of an administrative database. Objectives: The aim of our study was to investigate the distribution of spending for the entire episode of care among nonelderly, commercially insured patients undergoing elective, inpatient anterior cervical discectomy and fusion (ACDF) surgeries for degenerative cervical pathology. Methods: Using a private insurance claims database, we identified patients who underwent single-level, inpatient ACDF for degenerative spinal disease. Patients were selected using a combination of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Entire episode of care was defined as 6-months before (preoperative) to 6 months after (postoperative) the surgical admission. Results: In our cohort containing 33 209 patients, perioperative median spending per patient (MSPP) within the year encompassing surgery totaled $37 020 (interquartile range [IQR] $28 363-$49 206), with preoperative, surgical admission, and postoperative spending accounting for 9.8%, 80.7%, and 9.5% of total spending, respectively. Preoperatively, MSPP was $3109 (IQR $1806-$5215), 48% of patients underwent physical therapy, and 31% underwent injections in the 6 months period prior to surgery. Postoperatively, MSPP was $1416 (IQR $398-$3962), and unplanned hospital readmission (6% incidence) accounted for 33% of the overall postoperative spending. Discharge to a nonhome discharge disposition was associated with higher postoperative spending ($14 216) compared with patients discharged home ($1468) and home with home care ($2903), P < .001. Conclusion: Understanding the elements and distribution of perioperative spending for the episode of care in patients undergoing ACDF surgery for degenerative conditions is important for health care planning and resource allocation.

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“…lumbar) reported a 90-day ED visit rate of 9.4%, and independent risk factors were younger age, baseline opioid intake, chronic obstructive pulmonary disorder, and a larger number of surgically treated vertebral levels. 25 Patients with a 90-day ED visit also had a significantly lower 3-month EQ-5D score. 25 Another study by Jain et al focusing on primary lumbar fusion reported a 30-day ED visit rate of 12.8% with some similar predictors to our model, including Black race, ALIF, and ≥ 3 surgically treated levels.…”

Section: Fig 2 Nomogram Representing Prediction Model For 30-day Read...mentioning

confidence: 91%

“…25 Patients with a 90-day ED visit also had a significantly lower 3-month EQ-5D score. 25 Another study by Jain et al focusing on primary lumbar fusion reported a 30-day ED visit rate of 12.8% with some similar predictors to our model, including Black race, ALIF, and ≥ 3 surgically treated levels. 26 ALIF operations have been shown to be associated with increased rates of postoperative complications, readmissions, and hospital costs.…”

Section: Fig 2 Nomogram Representing Prediction Model For 30-day Read...mentioning

confidence: 91%

Patient-specific prediction model for clinical and quality-of-life outcomes after lumbar spine surgery

Lubelski

Feghali

Nowacki

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVEPatient demographics, comorbidities, and baseline quality of life (QOL) are major contributors to postoperative outcomes. The frequency and cost of lumbar spine surgery has been increasing, with controversy revolving around optimal management strategies and outcome predictors. The goal of this study was to generate predictive nomograms and a clinical calculator for postoperative clinical and QOL outcomes following lumbar spine surgery for degenerative disease.METHODSPatients undergoing lumbar spine surgery for degenerative disease at a single tertiary care institution between June 2009 and December 2012 were retrospectively reviewed. Nomograms and an online calculator were modeled based on patient demographics, comorbidities, presenting symptoms and duration of symptoms, indication for surgery, type and levels of surgery, and baseline preoperative QOL scores. Outcomes included postoperative emergency department (ED) visit or readmission within 30 days, reoperation within 90 days, and 1-year changes in the EuroQOL-5D (EQ-5D) score. Bootstrapping was used for internal validation.RESULTSA total of 2996 lumbar surgeries were identified. Thirty-day ED visits were seen in 7%, 30-day readmission in 12%, 90-day reoperation in 3%, and improvement in EQ-5D at 1 year that exceeded the minimum clinically important difference in 56%. Concordance indices for the models predicting ED visits, readmission, reoperation, and dichotomous 1-year improvement in EQ-5D were 0.63, 0.66, 0.73, and 0.84, respectively. Important predictors of clinical outcomes included age, body mass index, Charlson Comorbidity Index, indication for surgery, preoperative duration of symptoms, and the type (and number of levels) of surgery. A web-based calculator was created, which can be accessed here: https://riskcalc.org/PatientsEligibleForLumbarSpineSurgery/.CONCLUSIONSThe prediction tools derived from this study constitute important adjuncts to clinical decision-making that can offer patients undergoing lumbar spine surgery realistic and personalized expectations of postoperative outcome. They may also aid physicians in surgical planning, referrals, and counseling to ultimately lead to improved patient experience and outcomes.

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Emergency Department Visits After Elective Spine Surgery

Cited by 17 publications

References 21 publications

Effect of Perioperative Opioid Use on Patients Undergoing Hip Arthroscopy

Effect of Perioperative Opioid Use on Patients Undergoing Hip Arthroscopy

Health Care Resource Utilization in Commercially Insured Patients Undergoing Anterior Cervical Discectomy and Fusion for Degenerative Cervical Pathology

Patient-specific prediction model for clinical and quality-of-life outcomes after lumbar spine surgery

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