Factors associated with emergency room visits within 30 days of outpatient foot and ankle surgeries

Abstract

The number of emergency department (ED) visits within 30 days after elective surgery has been utilized as a quality measure by many institutions. The significance of the measure as a postoperative complication in foot and ankle surgery, and risk factors for it, are unknown. We conducted a retrospective cohort study involving 386 patients to determine risk factors associated with ED visits after outpatient foot and ankle surgeries. After adjusting for clinically relevant covariates, we found that previous ED visits within 6 months of surgery, and nonelective surgeries were associated with the postoperative ED visit. Having private insurance was protective against postoperative ED visits. Though these risk factors may not be easily modifiable by surgeons, understanding them may improve patient education and transitional care to prevent overcrowding of the ED.KEYWORDS Emergency department; insurance; readmission; surgical complications F oot and ankle surgeries have a low complication rate, but certain patients are predisposed to such events. These complications include surgical site infections, venous thrombotic events, acute blood loss causing anemia, nerve injury, and pain unresponsive to oral analgesics. Complications are devastating for patients and costly for health care institutions.1 They may require additional office and emergency department (ED) visits, admission to a hospital, or further surgery.2 ED visits after elective surgery have recently been utilized as a quality measure by many institutions. 3Readmission after ED presentation may represent major complications after surgery, but many complications present to an ED without subsequent admission. Presentation to an ED is common even after elective surgeries, 4,5 and some of these unplanned visits can be preventable with good postsurgical as well as physician-patient coordination. 6 The occurrence of unplanned postoperative ED visits is significant in terms of ED crowding and increased health care costs and spending. To the authors' knowledge, no studies have evaluated postoperative ED visits after foot and ankle surgery. Therefore, the significance of this quality measure relative to actual postsurgical complications is unknown in foot and ankle surgeries.The purpose of the study was to identify risk factors associated with ED visits within 30 days after foot and ankle surgeries. METHODSWe enrolled adult patients 18 years or older who had foot and ankle surgery from January 2015 to December 2016 at the Baylor Scott and White Health Central Division campuses in Temple, Round Rock, Marble Falls, Waco, and College Station. Patients who presented to the ED after foot/ankle surgeries were identified from our department's quality measure data. To act as controls, we randomly selected an equal number of patients who did not present to the ED within 30 days after surgery. No matching was performed. We excluded (1) inhouse surgical cases, (2) patients with any record of relocation within 30 days of the surgery who no longer utilized the Scott and Whit...

Popliteal Versus Local Field Block for Pain-Related Postoperative Unplanned Emergency Room Visits After Foot and Ankle Surgery

“…Also, we were not able to capture those patients who presented to EDs outside of our network. While dropout rate is low in our institutions, 13 this underrepresents complications after surgery. We do not, however, anticipate any association between block group and dropout rate.…”

“…Emergency department (ED) visits create an increased burden within a hospital system, as well as potentially leading to overcrowding, which can delay care for more acute pathologies. 13 In our previous study, we identified pain as the number one cause of presentation to the ED after foot and ankle surgery. 13 Capdevila et al 8 have shown that with a popliteal block application, patients have reported improved pain, measured using visual analog scale pain scores, within the acute postoperative period, and that this resulted in an increase in the amount of time to first narcotic medication required.…”

Outpatient surgery in patients with ankle fractures minimises hospital admissions and utilisation of healthcare resources

“…Based on these findings, we suggest that a safe and properly implemented outpatient protocol may be beneficial in mitigating the risk of inpatient viral transmission, safeguarding frontline healthcare workers, and conserving finite resources. Examining unplanned returns to care after surgery has largely been employed as a quality improvement metric [18], but now has garnered importance from a public health perspective, given the current pandemic. Two previous studies examining the rate of 30-day unplanned ED visits after foot and ankle surgery report rates of 11-41% [18,19].…”

“…Examining unplanned returns to care after surgery has largely been employed as a quality improvement metric [18], but now has garnered importance from a public health perspective, given the current pandemic. Two previous studies examining the rate of 30-day unplanned ED visits after foot and ankle surgery report rates of 11-41% [18,19]. However, when one study isolated cases to outpatient surgery and surgery-related complaints, this range narrowed to approximately 11-17%, with pain being amongst the most common reasons for ED presentation [19,20].…”

“…Examining unplanned returns to care after surgery has largely been employed as a quality improvement metric [ 18 ], but now has garnered importance from a public health perspective, given the current pandemic. Two previous studies examining the rate of 30-day unplanned ED visits after foot and ankle surgery report rates of 11–41% [ 18 , 19 ].…”