Factors affecting emergency department visits, readmissions, and reoperations within 30 days of ankle fracture surgery- an institutional retrospective study

Prather, John C.; Alexander, Bradley; Halstrom, Jared R; Sutherland, Charlie; Patel, Akshar H.; McGwin, Gerald; Shah, Ashish

doi:10.1016/j.injury.2020.07.044

Cited by 8 publications

(14 citation statements)

References 27 publications

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“…Although intuitively, one might expect older patients to utilize the ED more, prior studies have described greater ED utilization among younger patients following total hip and knee arthroplasty, anterior crucial ligament reconstruction, and ankle fracture surgery as compared to older patients. 7 , 13 , 31 This is potentially due to the greater effect of pain in younger patient populations. Additionally, the increased comorbidity burden of older patients was accounted for with the multivariate nature of the analyses performed.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have examined ED visits following elective foot and ankle procedures and open reduction and internal fixation (ORIF) for treatment of ankle fracture. 2 , 31 , 39 These studies report that postoperative ED visits are common, with 30-day incidences ranging from 7% to 22%. However, cohort sizes have been limited to less than 600 patients.…”

Section: Introductionmentioning

confidence: 99%

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Emergency Department Visits Within 90 Days of Total Ankle Replacement

Ratnasamy

Kammien

Gouzoulis

et al. 2022

Foot & Ankle Orthopaedics

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Background: Total ankle replacement (TAR) utilization in the United States has steeply increased in recent decades. Emergency department (ED) visits following TAR impacts patient satisfaction and health care costs and warrant exploration. Methods: This retrospective cohort study utilized the 2010 to 2019 M91Ortho PearlDiver data set to identify TAR patients with at least 90 days of follow-up. PearlDiver contains billing claims data across all sites of care throughout the United States for all indications for care. Patient factors extracted included age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which surgery was performed, insurance plan, and postoperative hospital length of stay. Ninety-day postoperative ED visit incidence, timing, frequency, and primary diagnoses were identified and compared to 1-year postoperative ED visit baseline data. Univariate and multivariate logistic regression analyses were used to determine risk factors for ED visits. Results: Of 5930 TAR patients identified, ED visits within 90 days were noted for 497 (8.4%) patients. Of all ED visits, 32.0% occurred within 2 weeks following surgery. Multivariate analysis revealed several predictors of ED utilization: younger age (odds ratio [OR] 1.35 per decade decrease), female sex (OR 1.20), higher ECI (OR 1.32 per 2-point increase), TAR performed in the western US (OR 1.34), and Medicaid coverage (OR 2.70; 1.71-4.22 relative to Medicare) ( P < .05 each). Surgical site issues comprised 78.0% of ED visits, with surgical site pain (57.0%) as the most common problem. Conclusion: Of 5930 TAR patients, 8.4% returned to the ED within 90 days of surgery, with predisposing demographic factors identified. The highest incidence of ED visits was in the first 2 postoperative weeks, and surgical site pain was the most common reason. Pain management pathways following TAR should be able to be adjusted to minimize the occurrence of postoperative ED visits, thereby improving patient experiences and decreasing health care utilization/costs. Level of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergency Department Visits Within 90 Days of Total Ankle Replacement

Ratnasamy

Kammien

Gouzoulis

et al. 2022

Foot & Ankle Orthopaedics

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Section: Discussionmentioning

confidence: 99%

“…One study found no notable difference in 30-day ED visits post-ORIF between patients with government insurance, private insurance, and no insurance. 10 The association between insurance status and ED visits after ankle surgery is likely dependent on numerous socioeconomic factors but may play a role in identifying patients at high risk for postoperative acute care utilization. 20,21 In the first two postoperative weeks, more than twothirds of ED visits had primary reports that directly involved the surgical site, the most common being unspecified surgical site issues and pain.…”

Section: Figurementioning

confidence: 99%

“…ED visits are reportedly common after elective foot and ankle surgery, with incidences ranging from 7% to 22%. [9][10][11] These studies, however, used single-institution cohorts with fewer than 600 patients evaluated within a 30-day postoperative period. Larger, nationwide studies are important for examining trends in postoperative ED utilization across the country.…”

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confidence: 99%

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Ninety-Day Emergency Department Visits After Ankle Fracture Surgery

Kammien

Ratnasamy

Joo

et al. 2022

J Am Acad Orthop Surg

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Introduction: Emergency department (ED) visits after orthopaedic procedures such as ankle fracture open reduction and internal fixation (ORIF) have received less attention than other outcomes. This study analyzed 90-day ED visits after ankle fracture surgery in a national database to better characterize the incidence, timing, risk factors, and reasons. Methods: Ankle fractures undergoing ORIF were extracted from the PearlDiver M91Ortho 2010 to 2020Q3 data set. Patients were excluded for age younger than 18 years, presence of concomitant fractures, and ,90 days of database follow-up. Patient age, sex, Elixhauser Comorbidity Index score, region of the country, and insurance plan were analyzed as predictors for 90-day ED utilization using multivariate logistic regression. Incidence of readmissions and incidence, timing, risk factors, and reasons for ED visits were determined. Results: Of 87,662 ankle fracture ORIF patients identified, ED visits were noted within 90 days of surgery for 10,087 (11.5%) while 4,030 (4.6%) were readmitted. One ED visit was noted for 6,102 patients, two visits for 2,654, three visits for 787, and more than three visits for 544. The greatest weekly incidence of ED visits was observed in weeks 1 and 2, with 2.9% and 3.1% of the entire cohort visiting in each week respectively. Factors independently associated with 90-day ED utilization included younger age (odds ratio [OR] 1.21 per decade decrease, P , 0.001), greater Elixhauser Comorbidity Index score (OR 1.40 per two-point increase, P , 0.001), and Medicaid insurance (OR 1.92, P , 0.001). In the first two postoperative weeks, 71% of ED visits were attributed to issues directly involving the surgical site while in subsequent weeks, most visits did not involve the surgical site (65%). Discussion: Many patients visit the ED after ankle fracture surgery. The greatest ED utilization was during the first two postoperative weeks, and reasons for visits were defined. These findings have implications for optimizing care pathways and targeting resource allocation.

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