Division of Orthopaedic Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada.
J Arthroplasty. 2021 Apr;36(4):1232-1238. doi: 10.1016/j.arth.2020.10.048. Epub 2020 Nov 17.
Interest in postoperative healthcare utilization has increased following the implementation of episode-of-care funding for elective orthopedic surgery. Most efforts have focused on readmission; however, little has been reported on emergency department (ED) presentation. We analyzed elective, primary total hip or knee arthroplasty (THA and TKA) cases to determine the rate, reasons, risk factors, timing, and hospital cost associated with 30-day ED presentations.
An observational study of patients who underwent primary, elective TKA and THA between January 1, 2016, and December 31, 2017, was performed. The primary outcome was an ED visit within 30-days of the index operation. Secondary outcomes included reasons, risk factors, timing, and hospital cost of ED visits. A multivariable logistic regression was undertaken to determine patient factors associated with ED presentation.
Overall, 1690 patients were included, of which 9.2% presented to the ED within 30-days of surgery. Approximately two-thirds of the visits were after-hours, and most were discharged home without readmission (81.4%). The most commonly reported reasons were wound concerns (30.1%) and pain (20.5%). Older age (OR 1.1, P = .03) and preoperative dyspnea (OR 2.1, P < .001) increased the odds of ED visits. The mean cost of an ED visit was significantly greater after-hours (P = .015).
Overall, 1 in 10 patients undergoing TKA/THA presented to the ED within 30-days of surgery, of which over 80% were not readmitted, and most occurred after-hours where cost is greatest. Our observations suggest ED visits following TKA/THA are common, and most are likely preventable. Future efforts should focus on developing interventions to reduce these visits.
在为择期骨科手术实施病例组付费后，人们对术后医疗保健利用的兴趣有所增加。大多数努力都集中在再入院上；然而，关于急诊部（ED）就诊的报道却很少。我们分析了择期初次全髋关节或膝关节置换术（THA 和 TKA）病例，以确定与 30 天内 ED 就诊相关的率、原因、危险因素、时间和医院费用。
对 2016 年 1 月 1 日至 2017 年 12 月 31 日期间接受初次择期 TKA 和 THA 的患者进行了一项观察性研究。主要结果是指数手术后 30 天内的 ED 就诊。次要结果包括 ED 就诊的原因、危险因素、时间和医院费用。进行了多变量逻辑回归分析，以确定与 ED 就诊相关的患者因素。
总体而言，共纳入 1690 例患者，其中 9.2%在手术后 30 天内到 ED 就诊。大约三分之二的就诊是在非工作时间，并且大多数在出院后没有再入院（81.4%）。最常见的报告原因是伤口问题（30.1%）和疼痛（20.5%）。年龄较大（OR 1.1，P =.03）和术前呼吸困难（OR 2.1，P <.001）增加了 ED 就诊的几率。非工作时间 ED 就诊的平均费用明显更高（P =.015）。
总体而言，接受 TKA/THA 的患者中有 10%在手术后 30 天内到 ED 就诊，其中超过 80%没有再入院，大多数发生在非工作时间，费用最高。我们的观察结果表明，TKA/THA 后 ED 就诊很常见，而且大多数可能是可以预防的。未来的工作应重点制定干预措施，以减少这些就诊。
