Emergency Department Visits After Elective Spine Surgery.

Authors

• Jeffrey M Hills
• Inamullah Khan
• Ahilan Sivaganesan
• Benjamin Weisenthal
• Joshua Daryoush
• Marjorie Butler
• Mohamad Bydon
• Kristin R Archer
• Anthony Asher
• Clinton J Devin

Publication/Presentation Date

8-1-2019

Abstract

BACKGROUND: Emergency department (ED) overuse is a costly and often neglected source of postdischarge resource utilization after spine surgery. Failing to investigate drivers of ED visits represents a missed opportunity to improve the value of care in spine patients.

OBJECTIVE: To identify the prevalence, drivers, and timing of ED visits following elective spine surgery.

METHODS: Patients undergoing elective spine surgery for degenerative disease at a major medical center were enrolled in a prospective longitudinal registry. Patient and surgery characteristics, and patient-reported outcomes were recorded at baseline and 3 mo after surgery, along with self-reported 90-d ED visits. A multivariable regression model was used to identify independent factors associated with 90-d ED visits. For a sample of patients presenting to our institution's ED, charts were reviewed to identify the reason and time to ED postdischarge.

RESULTS: Of 2762 patients, we found a 90-d ED visit rate of 9.4%. One-third of patients presented to our institution's ED and of these, 70% presented due to pain or medical concerns at 9 and 7 d postdischarge, respectively, with 60% presenting outside normal clinic hours. Independent risk factors for 90-d ED visits included younger age, preoperative opioid use, chronic obstructive pulmonary disorder, and more vertebral levels involved.

CONCLUSION: Nearly 10% of elective spine patients had 90-d ED visits not requiring readmission. Pain and medical concerns accounted for 70% of visits at our center, occurring within 10 d of discharge. This study provides the clinical details and a timeline necessary to guide individualized interventions to prevent unnecessary, costly ED visits after spine surgery.

Volume

85

Issue

2

First Page

258

Last Page

258

ISSN

1524-4040

Published In/Presented At

Hills, J. M., Khan, I., Sivaganesan, A., Weisenthal, B., Daryoush, J., Butler, M., Bydon, M., Archer, K. R., Asher, A., & Devin, C. J. (2019). Emergency Department Visits After Elective Spine Surgery. Neurosurgery, 85(2), E258–E265. https://doi.org/10.1093/neuros/nyy445

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

30272232

Department(s)

Administration and Leadership

Document Type

Article