Predictors for Surgery-Related Emergency Department Visits within 30 Days of Foot and Ankle Surgeries

Shibuya, Naohiro; Graney, Colin; Patel, Himani; Jupiter, Daniel C.

doi:10.1053/j.jfas.2018.05.003

Cited by 9 publications

(10 citation statements)

References 18 publications

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“…Multiple studies have quantified the frequency of and identified risk factors contributing to unplanned ED/UC visits after outpatient orthopaedic surgeries. 11 , 18 , 20 21 22 23 24 Although the recorded incidence of ED/UC visit is generally lower, variability exists within the literature. 11 , 18 , 20 21 22 23 24 Sivasundaram et al 20 reported a slightly lower incidence of ED visit utilization (4.4%) within 30 days of outpatient surgery, compared with our study (5.4%), and 6.9% of patients presented to an unplanned ED within 7 days of surgery in the study of Navarro et al.…”

Section: Discussionmentioning

confidence: 99%

“… 11 , 18 , 20 21 22 23 24 Although the recorded incidence of ED/UC visit is generally lower, variability exists within the literature. 11 , 18 , 20 21 22 23 24 Sivasundaram et al 20 reported a slightly lower incidence of ED visit utilization (4.4%) within 30 days of outpatient surgery, compared with our study (5.4%), and 6.9% of patients presented to an unplanned ED within 7 days of surgery in the study of Navarro et al. Contrary to our study, most unplanned ED/UC visits reported in the literature are accompanied by a chief report of postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

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Unplanned Emergency and Urgent Care Visits After Outpatient Orthopaedic Surgery

Williams¹,

Smith²,

Only³

et al. 2021

JAAOS Glob Res Rev

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Introduction This study sought to determine (1) incident risk, (2) chief report, (3) risk factors, and (4) total cost of unplanned healthcare visits to an emergency and/or urgent care (ED/UC) facility within 30 days of an outpatient orthopaedic procedure. Methods This was a retrospective database review of 5,550 outpatient surgical encounters from a large metropolitan healthcare system between 2012 and 2016. Statistical analysis consisted of measuring the ED/UC incident risk, respective to the procedures and anatomical region. Patient-specific risk factors were evaluated through multigroup comparative statistics. Results Of the 5,550 study patients, 297 (5.4%) presented to an ED/UC within 30 days of their index procedure, with 23 (0.4%) needing to be readmitted. Native English speakers, patients older than 45 years, and nonsmokers had significant reduced relative risk of unplanned ED or UC visit within 30 days of index procedure ( P < 0.01). In addition, hand tendon repair/graft had the greatest risk incidence for ED/UC visit (11.0%). Unplanned ED/UC reimbursements totaled $146,357.34, averaging $575.65 per visit. Discussion This study provides an evaluation of outpatient orthopaedic procedures and their relationship to ED/UC visits. Specifically, this study identifies patient-related and procedural-related attributes that associate with an increased risk for unplanned healthcare utilization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Unplanned Emergency and Urgent Care Visits After Outpatient Orthopaedic Surgery

Williams¹,

Smith²,

Only³

et al. 2021

JAAOS Glob Res Rev

View full text Add to dashboard Cite

show abstract

“…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]. In terms of readmissions, two larger studies investigating readmissions after surgical fixation of an ankle fracture showed readmission rates varying from approximately 3-5%, with infections being reported as the most common cause in one study [21,22].…”

Section: Discussionmentioning

confidence: 99%

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

Bullock¹,

Gutierrez-Naranjo

DelBello³

et al. 2020

International Orthopaedics (SICOT)

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Purpose The recent outbreak of the novel coronavirus (SARS-CoV-2) has emphasised the need to minimise hospital admissions and utilisation of healthcare resources. The purpose of this study was to examine the outcomes of an outpatient surgery protocol for acute closed ankle fractures. Methods In this retrospective study, 262 patients underwent outpatient surgery for their closed ankle fractures at our level-1 trauma centre. A total of 196 patients met our inclusion criteria and were ultimately included in the final analysis. Our primary outcomes' measures included post-operative admission to the emergency department within 30 days after surgery and unplanned hospital readmission within 30 days after surgery. Our secondary outcome measure included the incidence of surgical site infection (SSI) within 12 weeks after surgery. Results Thirty-two patients (16.3%) had an unplanned emergency department visit within 30 days of fracture fixation and two patients (1.0%) required hospital readmission within 30 days of their surgery. Sixteen patients (8.2%) developed SSI, which included 11 (5.6%) superficial and five (2.6%) deep infections. Conclusion Strategic outpatient management of acute closed ankle fractures is associated with acceptable rates of unplanned emergency department visits, hospital readmissions, and SSIs. In the context of the recent SARS-CoV-2 outbreak, outpatient management of these injuries may aide in the mitigation of nosocomial infections and the preservation of finite healthcare resources.

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“…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%

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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Predictors for Surgery-Related Emergency Department Visits within 30 Days of Foot and Ankle Surgeries

Cited by 9 publications

References 18 publications

Unplanned Emergency and Urgent Care Visits After Outpatient Orthopaedic Surgery

Unplanned Emergency and Urgent Care Visits After Outpatient Orthopaedic Surgery

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

Emergency Department Visits Within 90 Days of Total Ankle Replacement

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