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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...