Unplanned Emergency Department Visits within 30 Days of Mastectomy and Breast Reconstruction

Abstract

Background: Unplanned emergency department (ED) visits are often overlooked as an indicator of care quality. Our objectives were to (1) determine the rate of 30-day ED visits following mastectomy with or without immediate reconstruction, (2) perform a risk analysis of potential factors associated with ED return, and (3) assess for potentially preventable visits with a focus on returns for pain. Methods: Using the Healthcare Cost and Utilization Project data, we identified adult women who underwent mastectomy with or without reconstruction. Multivariable logistic regression was performed to evaluate risk of unplanned ED visits. We identified and sorted diagnostic codes to investigate why patients were seeking ED care. Additionally, we performed a subgroup analysis on patients returning with a pain-related diagnosis to evaluate risk. Results: Of 159,275 cases of mastectomy with or without immediate reconstruction, 4,917 (3.1%) experienced an unplanned return to the ED within 30 days of operation. Being younger, having any payer type other than a private payer, or having any number of comorbid conditions resulted in increased odds of revisit to ED. A substantial proportion of those who returned (23%) presented with a pain-related diagnosis. Only 0.9% of cases with a 30-day ED return were readmitted. Conclusions: Numerous patients return to the ED within 30-days of mastectomy with or without immediate reconstruction. There is a need for policy makers and physicians to implement strategies to reduce discretionary ED utilization, specifically among younger or publically insured patients. Combining unplanned ED visits with readmission rates as a care quality indicator warrants consideration.

Thirty-day Emergency Department Utilization after Distal Radius Fracture Treatment: Identifying Predictors and Variation

“…We found that 2% of surgical patients and 4% of nonsurgical patients returned to the ED 30 days after treatment with a DRF-related diagnosis. In addition, similar to the study by Curtin and Hernandez-Boussard 13 and other researchers examining the returns to acute care after a procedure, 7,8 we found a substantial portion of patients visiting the ED return with a potentially preventable pain diagnosis. Methods to reduce postoperative pain may include patient education, nonopioid pain management, care provided through outpatient clinic services, proper counseling on anxiety and fear, and anesthesia-guided protocols anticipating the need for postoperative pain relief.…”

“…22 In addition, the 30-day metric is commonly used in the literature to examine unplanned readmission rates and ED utilization after a procedure. 7,8,22…”

“…6 Therefore, researchers have investigated the utilization of the ED for patients undergoing common surgical procedures such as mastectomy, breast reconstruction, major joint replacement, and thoracic surgery to identify patients with an increased risk of returning to the ED after a surgery. 7–10 However, these studies fail to assess the diagnoses upon ED visits for potential relation to the condition or procedure of interest.…”

The Severity of Postoperative Pancreatic Fistula Predicts 30-Day Unplanned Hospital Visit and Readmission after Pancreaticoduodenectomy: A Single-Center Retrospective Cohort Study

“…In addition, unplanned hospital utilization after discharge was 23.4% in our series. The clinical importance of unplanned hospital visits has been investigated in the field of postoperative care [ 14 , 15 , 16 , 17 ]. Unplanned hospital visits after PD should be considered as a complication or an indicator of the quality of healthcare, just like hospital readmission.…”

“…In addition to readmission, unplanned hospital visits are also troublesome postoperative events for patients after discharge [ 14 , 15 , 16 , 17 ]. The event not only impacts patients’ postoperative recovery and satisfaction but also increases the financial burden and additional resource utilization [ 3 , 4 , 5 , 7 , 18 ].…”