Purpose To determine the frequency of visits to emergency departments (EDs) for non-urgent and urgent ocular conditions and risk factors associated with utilization of the ED for non-urgent and urgent ocular problems. Design Retrospective longitudinal cohort analysis Participants All enrollees age ≥ 21 years old in a U.S. managed care network from 2001-2014. Methods We identified all enrollees who presented to an ED with ocular conditions identified by International Classification of Diseases, 9th Revision billing codes. We designated each diagnosis as “urgent”, “non-urgent”, or “other”. We assessed the frequency of ED visits for urgent and non-urgent ocular conditions and how they changed over time. Next, we performed multivariable Cox regression modeling to determine factors associated with visiting an ED for urgent or non-urgent ocular conditions. Main Outcome Measures Hazard ratios (HR) with 95% confidence intervals (CI) of visiting an ED for urgent or non-urgent ocular conditions. Results Of the 11,160,833 enrollees eligible for this study, 376,680 (3.4%) had ≥1 ED visit for an eye-related problem over a mean ± standard deviation of 5.4 ± 3.3 years follow-up. Among the 376,680 enrollees who visited the ED for ocular conditions, 86,473 (23.0%) had ≥1 ED visits with a non-urgent ocular condition and 25,289 (6.7%) had ≥1 ED visit with an urgent ocular condition. ED utilization for non-urgent ocular problems was associated with younger age (p<0.0001 for all comparisons), black race or Latino ethnicity (p<0.0001 for both), male sex (p<0.0001), lower income (p<0.0001 for all comparisons), and those who frequently presented to an ED for non-ophthalmologic medical problems in a given year (p<0.0001). Enrollees with established eye care professionals had a 10% reduced hazard of visiting the ED for non-urgent ocular conditions (adjusted HR=0.90 [CI 0.88-0.92], p<0.0001). Conclusions Nearly one quarter of all enrollees in this managed care network who visited the ED for ocular problems were diagnosed with non-urgent conditions. Better educating and incentivizing patients to seek care for non-urgent ocular diseases in an office-based setting instead of an ED could potentially yield considerable cost savings without adversely affecting health outcomes and allow EDs to better serve patients with more severe problems.

This study suggests that the actual utilization of alvimopan leads to a reduction in prolonged ileus and LOS in patients who underwent colectomy. By accelerating postoperative recovery, alvimopan has the potential to benefit patients and health care systems by improving outcomes, ensuring patient comfort, and reducing cost.

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