Geisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17821, USA.
Surg Endosc. 2021 Aug;35(8):4750-4755. doi: 10.1007/s00464-020-07949-y. Epub 2020 Sep 1.
Emergency Department (ED) utilization following general surgery procedures is poorly understood and places immense strain on the healthcare system. Inefficient ED utilization is responsible for up to $38 billion in wasteful spending annually. Nearly 56% of ED visits may be avoidable. The aim of our study was to quantify ED utilization following elective cholecystectomy (CCY) and inguinal hernia repair (IHR), to characterize the impact and identify causes.
This retrospective study included patients across eight hospitals in a single health system undergoing elective CCY and IHR between January 2018 to June 2019. Patients who returned to the ED within 30 and 90 days were analyzed for hospital readmission, preventability (based on the Goldfield criteria), relation to index surgery and clinician communication within 48 h of presentation.
In total, 3678 patients had elective surgery in this timeframe. Of these, 476 patients (13.1%) visited the ED at least once within 90 days from their surgical admission discharge date and 114 were readmitted to the hospital (23.9%). Average length from discharge to ED presentation was 27.1 days. The mean cost associated with these ED visits was $974 per visit. 31.9% communicated with their clinician within 48 h of ED presentation. 73.9% of ED visits occurred between Monday - Friday and 51.5% took place between the hours of 8 am-5 pm. 46.6% of ED visits were related to the index operation and 40.7% of ED visits were deemed preventable.
While hospital readmissions have been scrutinized in the literature, relatively little is known about postoperative ED utilization. Our study is one of the first to document postoperative ED utilization up to 90 days after surgery. For just two common elective general surgery procedures, we found these visits were financially burdensome and led to ED discharge in > 75% of patients. Numerous opportunities to improve care were identified. Most ED visits occurred on weekdays and during daylight hours, suggesting an opportunity to utilize outpatient clinics in lieu of the ED. Nearly 50% were related to the operation and nearly 40% were preventable. Revamping the discharge instructions and post-discharge communication-including novel strategies leveraging telemedicine-by providers has the potential to dramatically decrease postoperative ED utilization.
普通外科手术后急诊部（ED）的使用情况了解甚少，这给医疗系统带来了巨大的压力。ED 的使用效率低下导致每年浪费高达 380 亿美元。近 56%的 ED 就诊可能是可以避免的。我们的研究旨在量化择期胆囊切除术（CCY）和腹股沟疝修补术（IHR）后的 ED 利用情况，分析其影响并确定原因。
这项回顾性研究包括在单个医疗系统的 8 家医院进行择期 CCY 和 IHR 的患者，时间为 2018 年 1 月至 2019 年 6 月。在术后 30 天和 90 天内返回 ED 的患者，分析其住院再入院情况、可预防性（根据 Goldfield 标准）、与索引手术的关系以及在出现症状后 48 小时内与临床医生的沟通情况。
在这段时间内，共有 3678 名患者进行了择期手术。其中，476 名患者（13.1%）在手术出院日期后 90 天内至少有一次到 ED 就诊，114 名患者需要住院治疗（23.9%）。从出院到 ED 就诊的平均时间为 27.1 天。这些 ED 就诊的平均费用为每次 974 美元。31.9%的患者在 ED 就诊后 48 小时内与他们的医生进行了沟通。73.9%的 ED 就诊发生在周一至周五，51.5%的就诊时间在上午 8 点至下午 5 点之间。46.6%的 ED 就诊与索引手术有关，40.7%的 ED 就诊可预防。
虽然医院再入院情况已经在文献中进行了审查，但对于术后 ED 的使用情况了解甚少。我们的研究是首次记录术后 ED 使用情况长达 90 天的研究之一。仅针对两种常见的择期普通外科手术，我们发现这些就诊给患者带来了经济负担，超过 75%的患者在 ED 出院。我们发现了许多可以改善治疗的机会。大多数 ED 就诊发生在工作日和白天，这表明有机会利用门诊诊所代替 ED。近 50%的就诊与手术有关，近 40%的就诊是可以预防的。提供者可以通过重新制定出院医嘱和出院后沟通方式（包括利用远程医疗的新策略），有潜力显著减少术后 ED 的使用。
