Emergency Department Visits Following Elective Total Hip and Knee Replacement Surgery: Identifying Gaps in Continuity of Care

Finnegan, Micaela A.; Shaffer, Robyn K.; Remington, Austin; Kwong, Jereen; Curtin, Catherine; Hernandez‐Boussard, Tina

doi:10.2106/jbjs.16.00692

Cited by 72 publications

(67 citation statements)

References 27 publications

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“…1,8,9 Specifically for ED visits after elective procedures, Finnegan et al evaluated patients who underwent total hip and knee arthroplasties. 10 They found that having Medicaid as primary insurance was statistically significantly associated with postoperative ED visits. Medicare was also a risk factor for ED visits compared to private insurance.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with emergency room visits within 30 days of outpatient foot and ankle surgeries

Shibuya

Patel

Graney

et al. 2018

Baylor University Medical Center Proceedings

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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...

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Section: Discussionmentioning

confidence: 99%

Factors associated with emergency room visits within 30 days of outpatient foot and ankle surgeries

Shibuya

Patel

Graney

et al. 2018

Baylor University Medical Center Proceedings

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“…Findings regarding median household income were mixed across studies. Among the four studies using this SEDH, two demonstrated signi cant associations between median household income and emergency care indicators (52,56) and the other two did not. (50, 55) (See Additional le 4)…”

Section: Incomementioning

confidence: 99%

“…To measure income differences, four studies that used this SEDH used median income household (divided into quartiles or thirds) (50,52,55,56) and one used presence versus absence of a reportable income. (59) (It re ects the ability to reach and to pay).…”

Section: Incomementioning

confidence: 99%

“…(54) (14) ED readmissions rate/Emergency reshopitalisation rate This indicator was used in three articles. Two of them analysed ED readmissions within 30 days postdischarge (55,56). One used this indicator to analyse the rate of hospital admissions through the ED in the year following a diagnosis of breast, colorectal, non-small cell lung or pancreatic cancer (57).…”

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confidence: 99%

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Assessing Health Care Equity Through Administrative Data-Derived Qquity Indicators and Socio-Economic Determinants of Health in Emergency Care: A Systematic Review

Morisod

Luta

Marti

et al. 2020

Preprint

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Background: Achieving equity in health care remains a challenge for health care systems worldwide and marked inequities in access and quality of care persist. The performance assessment of health care systems is often limited to quality and efficiency indicators. Identifying indicators of health care equity is an important first step in integrating the concept of equity into assessments of health care system performance. Because emergency care serves as the interface between ambulatory and inpatient care, it appears to be a key setting in which to begin this process.Methods: We conducted a systematic review of administrative data-derived health care equity indicators and their association with socio-economic determinants of health (SEDH) in emergency care settings. Ovid MEDLINE, EMBASE, PUBMED and Web of Science were searched for relevant studies using administrative data following PRISMA-equity guidelines. The outcomes of interest were indicators of health care equity and the associated SEDH they examine.Results: Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care sensitive condition-related ED visits were the two most frequently used indicators. The studies analysed equity based on seven SEDH: social deprivation, income, education level, social class, insurance coverage, health literacy and financial and non-financial barriers. Despite some conflicting results, all identified SEDH are associated with inequalities in access to and use of emergency care. Conclusion: The use of administrative data-derived indicators in combination with identified SEDH could improve the measurement of health care equity in emergency care settings across health care systems worldwide. Using a combination of indicators is likely to lead to a more comprehensive, well-rounded analysis of health care equity than using any one indicator in isolation. Though studies analysed focused on emergency care settings, it seems possible to extrapolate these indicators to measure equity in other areas of the health care system. Further studies elucidating root causes of health inequities in and outside the health care system are needed.

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“…(1) In a retrospective database study of 152,783 patients undergoing major joint replacements, 8883 (5.81%) of patients returned to the ED within 30 days, more common than 30-day readmissions of 5229 (3.42%), and pain was the most frequent single diagnosis at 25.75%. (2) Not uncommonly, patients return to a non-index hospital, which is not the hospital where surgery was performed originally. (3) The costs in such cases are higher, (4) as is the mortality.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Home Monitoring After Joint Replacement: Retrospective Outcome Study Comparing Cases With Matched Historical Controls (Preprint)

Yang¹,

Dervin²,

Madden³

et al. 2018

Preprint

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BACKGROUND A retrospective cohort study was conducted in patients undergoing postoperative home monitoring (POHM) following elective primary hip or knee replacements. OBJECTIVE The objectives of our study were to compare the cost per patient, readmissions rate, emergency room visits, and mortality within 30 days to the historical standard of care using descriptive analysis. METHODS After Research Ethics Board approval, patients who were enrolled and had completed a POHM study were individually matched to historical controls by age, American Society of Anesthesiology class, and procedure at a ratio 1:2. RESULTS A total of 54 patients in the study group and 107 in the control group were eligible for the analysis. Compared with the historical standard of care, the average cost per case was Can $5826.32 (SD 1418.89) in the POHM group and Can $9198.58 (SD 1513.59) for controls. After 30 days, there were 2 emergency room visits (3.7%) and 0 readmissions in the POHM group, whereas there were 8 emergency room visits (7.5%) and 2 readmissions (1.9%) in the control group. No mortalities occurred in either group. CONCLUSIONS The POHM study offers an early hospital discharge pathway for elective hip and knee procedures at a 38% reduction of the standard of care cost. The multidisciplinary transitional POHM team may provide a reliable forum to minimize readmissions, and emergency room visits within 30 days postoperatively. CLINICALTRIAL ClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/73WQ9QR6P)

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Emergency Department Visits Following Elective Total Hip and Knee Replacement Surgery: Identifying Gaps in Continuity of Care

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 72 publications

References 27 publications

Factors associated with emergency room visits within 30 days of outpatient foot and ankle surgeries

Factors associated with emergency room visits within 30 days of outpatient foot and ankle surgeries

Assessing Health Care Equity Through Administrative Data-Derived Qquity Indicators and Socio-Economic Determinants of Health in Emergency Care: A Systematic Review

Postoperative Home Monitoring After Joint Replacement: Retrospective Outcome Study Comparing Cases With Matched Historical Controls (Preprint)

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