Emergency Department Visit Within One Year Prior to Elective Total Joint Arthroplasty Is Predictive of Postoperative Return to Emergency Department Within 90 Days

Gabbard, Michael D.; Charters, Michael A.; Mahoney, Sean P.; North, W. Trevor

doi:10.1016/j.arth.2019.03.037

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…We did not find any association between the proximity of the most recent ED visit to the date of surgery and risk for postoperative visits. This is in contrary to the findings for lower extremity arthroplasty, where a significant association was reported [4]. While this disproved our hypothesis for this endpoint, it is likely that proximity of preoperative ED visits to the date of surgery is a covariate with frequency of ER visits and represents a surrogate for more frequent ER visits, which was controlled for in the multivariate analysis.…”

Section: Discussioncontrasting

confidence: 99%

“…Our multivariate analysis found that a single ED visit within a year prior to TSA resulted in a doubling of the risk of a postoperative ED visit. This is consistent with the findings from a similar lower extremity arthroplasty study [4]. An increasing number of visits to the ED within a year preoperatively demonstrated a dose-dependent relationship with the risk of postoperative ED visits; 62% of patients with 7 or more preoperative visits presented to the ED within 90 days postoperatively, representing a 13 times greater risk.…”

Section: Discussionsupporting

confidence: 90%

“…Numerous performance measurements are included in the model, but one of particular interest is postoperative presentation to the emergency department (ED). Recent research has found a high rate of presentation to the ED after lower extremity arthroplasty even with financial incentive from the CJR model to avoid its occurrence [4].…”

Section: Introductionmentioning

confidence: 99%

“…While several studies have examined risk factors for readmission after TSA [5,9,10], ED presentation often does not result in readmission and represents a separate and key metric in the CJR model for cost-efficacy and quality care. A recent study identified that one of the largest risk factors for ED presentation after lower extremity arthroplasty was presentation to the ED in the year prior to surgery [4].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Emergency Department Visits in the Year Prior to Total Shoulder Arthroplasty as a Risk Factor for Postoperative Emergency Department Visits

Werner

Bustos

Gean

et al. 2021

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Recent research has found a high rate of emergency department (ED) use after lower extremity arthroplasty; one study found a risk factor for ED presentation after lower extremity arthroplasty was presentation to the ED in the year prior to surgery. It is not known whether a similar association exists for total shoulder arthroplasty (TSA). Questions/Purposes: The goal of this study was to investigate the relationship between preoperative ED visits and postoperative ED visits after anatomic TSA. Methods: The 100% Medicare database was queried for patients who underwent anatomic TSA from 2005 to 2014. Emergency department visits within the year prior to the date of TSA were identified. Patients were additionally stratified by the number and timing of preoperative ED visits. The primary outcome measure was one or more postoperative ED visits within 90 days. A multivariate logistic regression analysis was used to control for patient demographics and comorbidities. Results: Of the 144,338 patients identified, 32,948 (22.8%) had an ED visit in the year prior to surgery. Patients with at least 1 ED visit in the year before surgery presented to the ED at a significantly higher rate than patients without preoperative ED visits (16% versus 6%). An ED visit in the year prior to TSA was the most significant risk factor for postoperative ED visits (in the multivariate analysis). The number of preoperative ED visits in the year prior to surgery demonstrated a significant dose-response relationship with increasing risk of postoperative ED visits. Conclusions: Postoperative ED visits occurred in nearly 10% of Medicare patients who underwent TSA in the period studied. More frequent presentation to the ED in the year prior to anatomic TSA was associated with increasing risk of postoperative ED visits. Future studies are needed to investigate the reasons for preoperative ED visits and if any modifiable risk factors are present to improve the ability to risk stratify and optimize patients for elective TSA.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%