Hillary J Mull1, Amy K Rosen, Martin P Charns, William J OʼBrien, Mary T Hawn, Kamal M F Itani, Steven D Pizer. 1. Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts (Drs Mull, Rosen, and Charns and Mr O'Brien); Department of Surgery, Boston University School of Medicine, Massachusetts (Drs Mull, Rosen, and Itani); Department of Health Law, Policy and Management, Boston University School of Public Health, Massachusetts (Drs Charns and Pizer); Palo Alto VA Medical Center, and Stanford University School of Medicine, California (Dr Hawn); Department of Surgery, VA Boston Healthcare System, and Harvard Medical School, Boston, Massachusetts (Dr Itani); and Partnered Evidence-Based Policy Resource Center, Department of Veterans Affairs, Boston, Massachusetts (Dr Pizer).
Abstract
BACKGROUND: Emergency department (ED) use following outpatient surgery may be associated with a surgery-related patient safety problem. We characterized ED use within 7 days of general, urology, orthopedic, ear/nose/throat, and podiatry surgical procedures and assessed factors associated with these visits by specialty. METHODS: We calculated the 2011-2013 postoperative ED visit rate for Veterans older than 65 years dually enrolled in the Veterans Health Administration (VA) and Medicare, examined diagnoses, and used logistic regression to model patient, procedure, and facility factors associated with ED care. RESULTS: Among 63 279 outpatient surgical procedures, 2778 (4.4%) resulted in an ED visit within 7 days; 23% of these were to non-VA facilities. Rates varied from more than 5% for urology and ear/nose/throat, to less than 3% for orthopedic and podiatry specialties. Genitourinary symptoms and surgical complications were common diagnoses across specialties. No patient, procedure, or facility factors were associated with ED use for every specialty. CONCLUSIONS: A small proportion of VA outpatient surgical procedures result in ED use. Notably, nearly one-fourth of the postoperative ED visits may be missed by the VA because they occur in non-VA facilities. ED visits for urinary issues or surgical complications may be preventable; however, factors associated with ED use vary by specialty, suggesting different approaches may be needed to improve outcomes.
BACKGROUND: Emergency department (ED) use following outpatient surgery may be associated with a surgery-related patient safety problem. We characterized ED use within 7 days of general, urology, orthopedic, ear/nose/throat, and podiatry surgical procedures and assessed factors associated with these visits by specialty. METHODS: We calculated the 2011-2013 postoperative ED visit rate for Veterans older than 65 years dually enrolled in the Veterans Health Administration (VA) and Medicare, examined diagnoses, and used logistic regression to model patient, procedure, and facility factors associated with ED care. RESULTS: Among 63 279 outpatient surgical procedures, 2778 (4.4%) resulted in an ED visit within 7 days; 23% of these were to non-VA facilities. Rates varied from more than 5% for urology and ear/nose/throat, to less than 3% for orthopedic and podiatry specialties. Genitourinary symptoms and surgical complications were common diagnoses across specialties. No patient, procedure, or facility factors were associated with ED use for every specialty. CONCLUSIONS: A small proportion of VA outpatient surgical procedures result in ED use. Notably, nearly one-fourth of the postoperative ED visits may be missed by the VA because they occur in non-VA facilities. ED visits for urinary issues or surgical complications may be preventable; however, factors associated with ED use vary by specialty, suggesting different approaches may be needed to improve outcomes.
Authors: Alex C Spyropoulos; Dimitrios Giannis; Jessica Cohen; Suja John; Anne Myrka; Damian Inlall; Michael Qiu; Saydi Akgul; Roger J Hyman; Jason J Wang Journal: Clin Appl Thromb Hemost Date: 2020 Jan-Dec Impact factor: 2.389