Risk Factors for Preventable Emergency Department Use After Outpatient Hand Surgery

Pragna N Shetty; Gianna M Guarino; Gongliang Zhang; Kavya K Sanghavi; Aviram M Giladi

doi:10.1016/j.jhsa.2022.05.012

Risk Factors for Preventable Emergency Department Use After Outpatient Hand Surgery

J Hand Surg Am. 2022 Sep;47(9):855-864. doi: 10.1016/j.jhsa.2022.05.012. Epub 2022 Jul 15.

Authors

Pragna N Shetty¹, Gianna M Guarino¹, Gongliang Zhang², Kavya K Sanghavi², Aviram M Giladi³

Affiliations

¹ The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
² The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Health Research Institute, Hyattsville, MD.
³ The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD. Electronic address: editor@curtishand.com.

PMID: 35843760
DOI: 10.1016/j.jhsa.2022.05.012

Abstract

Purpose: Emergency department (ED) visits for postoperative concerns that could be safely addressed in outpatient clinics have an impact on cost, quality measures, and care workflows. Patient-reported data (PRD) may give unique insights into individual-level factors that predict overuse of health care resources, and guide opportunities for intervention and prevention. We investigated the relationship between preoperative PRD and preventable ED use after outpatient hand surgery to determine whether the preoperative PRD can be used to identify patients at higher odds of having preventable ED visits.

Methods: All adult patients undergoing outpatient surgery at our hand center between January 1, 2018, and December 31, 2019, were included. Questionnaires, including the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) and pain interference (PI) scales, were completed before surgery. We used our regional health information exchange to identify ED visits within 90 days of surgery.

Results: Our cohort included 2,819 patients. Within 90 days after surgery, 106 (3.8%) had preventable ED visits. Race, insurance status, and transportation issues increased odds of a preventable ED visit. Multivariable models found that each 1-point increase in the preoperative PROMIS UE score was associated with 4% decreased odds of ED presentation (odds ratio, 0.96; 95% confidence interval, 0.94-0.99), and each 1-point increase in the preoperative PROMIS PI score was associated with 4% increased odds of ED presentation (odds ratio, 1.04; 95% confidence interval, 1.0-1.1). Any PROMIS UE or PI scores ≥1SDs worse than population norms increased the probability of a preventable ED visit, independent of other factors.

Conclusions: Worse preoperative PROMIS UE and PI scores were associated with increased odds of preventable ED visits. Preoperative PRD may allow for identification of outliers at higher risk for preventable ED use, and facilitate preventative interventions.

Type of study/level of evidence: Prognostic IV.

Keywords: Care access; emergency department use; global period; hand surgery; patient-reported data.

MeSH terms

Adult
Ambulatory Surgical Procedures*
Emergency Service, Hospital
Hand* / surgery
Humans
Outpatients
Patient Reported Outcome Measures
Risk Factors
Upper Extremity