High incidence of potentially preventable emergency department visits after major elective colorectal surgery

Eustache, Jules; Hopkins, Brent; Trépanier, Maude; Kaneva, Pepa; Fiore, Julio F.; Fried, Gerald M.; Feldman, Liane S.; Lee, Lawrence

doi:10.1007/s00464-021-08514-x

Cited by 4 publications

(7 citation statements)

References 22 publications

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“…Studies suggest that many emergency department visits after CRS could be prevented. 64 – 66 Our data suggests that Medicaid/uninsured patients are using the emergency department as substitute for outpatient care, further adding to costs.…”

Section: Discussionmentioning

confidence: 90%

Association of Cumulative Colorectal Surgery Hospital Costs, Readmissions, and Emergency Department/Observation Stays with Insurance Type

Jacobs

Tetley

Kim

et al. 2023

Journal of Gastrointestinal Surgery

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Background/Purpose Medicare’s Hospital Readmission Reduction Program disproportionately penalizes safety-net hospitals (SNH) caring for vulnerable populations. This study assessed the association of insurance type with 30-day emergency department visits/observation stays (EDOS), readmissions, and cumulative costs in colorectal surgery patients. Methods Retrospective inpatient cohort study using the National Surgical Quality Improvement Program (2013–2019) with cost data in a SNH. The odds of EDOS and readmissions and cumulative variable (index hospitalization and all 30-day EDOS and readmissions) costs were modeled adjusting for frailty, case status, presence of a stoma, and open versus laparoscopic surgery. Results The cohort had 245 private, 195 Medicare, and 590 Medicaid/uninsured cases, with a mean age 55.0 years (SD = 13.3) and 52.9% of the cases were performed on male patients. Most cases were open surgeries (58.7%). Complication rates were 41.8%, EDOS 12.0%, and readmissions 20.1%. Medicaid/uninsured had increased odds of urgent/emergent surgeries (aOR = 2.15, CI = 1.56–2.98, p < 0.001) and complications (aOR = 1.43, CI = 1.02–2.03, p = 0.042) versus private patients. Medicaid/uninsured versus private patients had higher EDOS (16.6% versus 4.1%) and readmissions (22.9% versus 14.3%) rates and higher odds of EDOS (aOR = 4.81, CI = 2.57–10.06, p < 0.001), and readmissions (aOR = 1.62, CI = 1.07–2.50, p = 0.025), while Medicare patients had similar odds versus private. Cumulative variable cost %change was increased for Medicare and Medicaid/uninsured, but Medicaid/uninsured was similar to private after adjusting for urgent/emergent cases. Conclusions Increased urgent/emergent cases in Medicaid/uninsured populations drive increased complications odds and higher costs compared to private patients, suggesting lack of access to outpatient care. SNH care for higher cost populations, receive lower reimbursements, and are penalized by value-based programs. Increasing healthcare access for Medicaid/uninsured patients could reduce urgent/emergent surgeries, resulting in fewer complications, EDOS/readmissions, and costs.

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Section: Discussionmentioning

confidence: 90%

Association of Cumulative Colorectal Surgery Hospital Costs, Readmissions, and Emergency Department/Observation Stays with Insurance Type

Jacobs

Tetley

Kim

et al. 2023

Journal of Gastrointestinal Surgery

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“…[IQR], 1-1) and the interval from discharge until their initial presentation to the ED ranging from 0 to 30 days (median, 7; IQR, [3][4][5][6][7][8][9][10][11][12][13][14][15]. A total of 4043 patients (7.9%) had an ED treat-and-release encounter, including 283 of 2125 patients (13.3%) who underwent esophagectomy, 288 of 3066 patients (9.4%) who underwent gastrectomy, 552 of 6098 patients (9.1%) who underwent pancreatectomy, 108 of 1430 patients (7.6%) who underwent small bowel resection, 2376 of 32 769 patients (7.3%) who underwent colorectal resection, and 436 of 6035 patients (7.2%) who underwent hepatobiliary resection (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Other ED encounters are necessary, as some patients require urgent diagnostic testing to assess for serious postoperative complications, such as pulmonary embolism or anastomotic leak. However, existing single‐center studies have shown that a significant percentage of postoperative ED visits are preventable 8,9 …”

Section: Discussionmentioning

confidence: 99%

“…The incidence of and reasons for ED treat‐and‐release encounters are poorly characterized in the literature compared to inpatient readmissions, particularly for patients who have undergone major gastrointestinal surgery for cancer 5–7 . Several single‐center studies of surgical patients, including patients undergoing bariatric and colorectal operations, have demonstrated that at least half of postoperative ED visits are preventable 8,9 . However, to our knowledge, a multicenter study of ED treat‐and‐release visits following major gastrointestinal operations has not been performed.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] Several single-center studies of surgical patients, including patients undergoing bariatric and colorectal operations, have demonstrated that at least half of postoperative ED visits are preventable. 8,9 However, to our knowledge, a multicenter study of ED treat-and-release visits following major gastrointestinal operations has not been performed. Therefore, our study objectives were to determine the incidence of and reasons for ED treat-and-release encounters among this population and identify patient characteristics and clinical factors associated with ED treatand-release encounters.…”

mentioning

confidence: 99%

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Evaluation of emergency department treat‐and‐release encounters after major gastrointestinal surgery

Brajcich

Johnson

Holl

et al. 2023

Journal of Surgical Oncology

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Background and Objectives: Emergency department (ED) utilization after gastrointestinal cancer operations is poorly characterized. Our study objectives were to determine the incidence of, reasons for, and predictors of ED treat-and-release encounters after gastrointestinal cancer operations. Methods: Patients who underwent elective esophageal, hepatobiliary, gastric, pancreatic, small intestinal, or colorectal operations for cancer were identified in the 2015-2017 Healthcare Cost and Utilization Project State Inpatient and State Emergency Department Databases for New York, Maryland, and Florida. The primary outcomes were the incidence of ED treat-and-release encounters and readmissions within 30 days of discharge.Results: Among 51 527 patients at 406 hospitals, 4047 (7.9%) had an ED treat-andrelease encounter, and 5573 (10.8%) had an ED encounter with readmission. In total, 40.7% of ED encounters were treat-and-release encounters. ED treat-and-release encounters were most frequently for pain (12.0%), device/ostomy complaints (11.7%), or wound complaints (11.4%). ED treat-and-release encounters predictors included non-Hispanic Black race/ethnicity (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.12-1.37) and Medicare (OR 1.27, or Medicaid (OR 1.82, 95% CI 1.62-2.40) coverage.Conclusions: ED treat-and-release encounters are common after major gastrointestinal operations, making up nearly half of postdischarge ED encounters. The reasons for ED treat-and-release encounters differ from those for ED encounters with readmissions.

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Association of Insurance Type With Inpatient Surgical 30-Day Readmissions, Emergency Department Visits/Observation Stays, and Costs

Jacobs

Kim

Tetley

et al. 2023

Annals of Surgery Open

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Objective: To assess the association of Private, Medicare (MC), and Medicaid/Uninsured (MU) insurance type with 30-day emergency department visits/observation stays (EDOS), readmissions, and costs in a safety-net hospital (SNH) serving diverse socioeconomic status patients. Background: MC’s hospital readmission reduction program (HRRP) disproportionately penalizes SNHs. Methods: This retrospective cohort study used inpatient National Surgical Quality Improvement Program (2013–2019) data merged with cost data. Frailty, expanded operative stress score, case status, and insurance type were used to predict odds of EDOS and readmissions, as well as index hospitalization costs. Results: The cohort had 1477 Private; 1164 MC; and 3488 MU cases with a patient mean age 52.1 years [SD = 14.7] and 46.8% of the cases were performed on male patients. MU [adjusted odds ratio (aOR) = 2.69, 95% confidence interval (CI) = 2.38–3.05, P < 0.001] and MC (aOR = 1.32, 95% CI = 1.11–1.56, P = 0.001) had increased odds of urgent/emergent surgeries and complications versus Private patients. Despite having similar frailty distributions, MU compared to Private patients had higher odds of EDOS (aOR = 1.71, 95% CI = 1.39–2.11, P < 0.001), and readmissions (aOR = 1.35, 95% CI = 1.11–1.65, P = 0.004), after adjusting for frailty, OSS, and case status, whereas MC patients had similar odds of EDOS and readmissions versus Private. Hospitalization variable cost %change was increased for MC (12.5%) and MU (5.9%), but MU was similar to Private after adjusting for urgent/emergent cases. Conclusions: Increased rates and odds of urgent/emergent cases in MU patients drive increased odds of complications and index hospitalization costs versus Private. SNHs care for higher cost populations while receiving lower reimbursements and are further penalized by the unintended consequences of HRRP. Increasing access to care, especially for MU patients, could reduce urgent/emergent surgeries resulting in fewer complications, EDOS/readmissions, and costs.

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High incidence of potentially preventable emergency department visits after major elective colorectal surgery

Cited by 4 publications

References 22 publications

Association of Cumulative Colorectal Surgery Hospital Costs, Readmissions, and Emergency Department/Observation Stays with Insurance Type

Association of Cumulative Colorectal Surgery Hospital Costs, Readmissions, and Emergency Department/Observation Stays with Insurance Type

Evaluation of emergency department treat‐and‐release encounters after major gastrointestinal surgery

Association of Insurance Type With Inpatient Surgical 30-Day Readmissions, Emergency Department Visits/Observation Stays, and Costs

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