Unplanned Emergency and Urgent Care Visits After Outpatient Orthopaedic Surgery

Abstract

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.

Telerehabilitation has similar clinical and patient-reported outcomes compared to traditional rehabilitation following total knee arthroplasty

“…Additionally, other studies [4, 8, 12] have evaluated relatively rare complications such as readmissions, whereas the present study accounted for readmission plus other unexpected healthcare visits such as outpatient visits, urgent care visits, and ED visits. These encounters account for a significant burden on the surgeon and healthcare system [15]. In this study of 326 patients, only 3 readmissions occurred (0.9%), whereas 25 other unplanned healthcare encounters occurred within 90 days (7.7%).…”

Postoperative emergency department visits for pain after outpatient orthopaedic surgery: did rescheduling hydrocodone make a difference?

“…An a priori power analysis was performed to determine the sample size necessary to detect a hypothesized 30% increase in the rate of postoperative ED visits for pain, from the previously published rate (5.4%) 3 to 7% of all outpatient orthopaedic procedures, utilizing an alpha of 0.05 and power of 80%. This provided a required sample size of 1650.…”

“…1 As the proportion of surgical procedures being performed as an outpatient has increased, there has been a corresponding increase in research regarding postoperative emergency department (ED) utilization. [2][3][4][5][6] Postoperative pain has been recognized as the most common indication for postoperative ED visit after elective hand surgery. 4,7 This finding was reported within months of the federal crackdown on hydrocodone and increased prescriber requirements for the narcotic pain medication.…”

“…In 2006, an estimated 34.7 million outpatient surgeries were performed in the United States, which accounted for over 60% of all surgical procedures performed 1. As the proportion of surgical procedures being performed as an outpatient has increased, there has been a corresponding increase in research regarding postoperative emergency department (ED) utilization 2–6…”