The hidden costs of Surgery: Perioperative Emergency Department Burden after General Surgery

Dana Telem, MD, Aurora Pryor, MD, Jie Yang, PhD, Andrew Bates, Ziqi Mheng, Mark Talamini. Stony Brook Medical Center

Background: Emergency department (ED) over-utilization is a leading cause of increased health care costs. Outcomes assessment following surgery focuses primarily on hospital readmissions. A paucity of data exists regarding ED burden.

Purpose: To establish 30-day postoperative ED utilization and identify patients with preventable visitation.

Methods: Using the SPARCS New York statewide longitudinal administrative database, 201,985 patients who underwent cholecystectomy (n=97,640), appendectomy (n=44,788) or inguinal hernia repair (n=58,957) from 2008-2010 were analyzed. Multiple logistic regression models analyzed all variables with p<0.1 on univariate models.

Results: In total, 16,680 (8.3%) patients presented to the ED within 30-days of operation of which 5,964 (35.8%) were admitted and 10,716 (64.2%) discharged. ED utilization, admission and discharge by procedure were as follows: cholecystectomy (9.5%, 40%, 60%), appendectomy (9.8%, 33.1%, 66.9%), and inguinal hernia (5.1%, 26.2%, 73.8%), respectively. Multivariate analysis demonstrated patients presenting to the ED were more likely to be black or hispanic, age<45, Medicaid/Medicare insured, and have comorbid conditions including pulmonary disease, diabetes, psychiatric disorders and renal failure(p<0.01). Operative morbidity did not increase risk. Patients discharged home were more likely to be age<45, black or Hispanic, Medicaid insured, and have psychiatric disorders versus those admitted(p<0.01).

Conclusion: Thirty-day postoperative ED utilization is significant and poses a burden to the health care system. The majority of ED visits do not result in admission questioning their necessity and identifying an opportunity for intervention and improvement in health care delivery – particularly in the young, minority, and Medicaid insured populations as well as in patients with psychiatric diagnoses.

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