Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
J Gastrointest Surg. 2021 Dec;25(12):3099-3107. doi: 10.1007/s11605-021-05050-w. Epub 2021 Jun 18.
Care delivered in hospital-based emergency departments (ED) is a target for cost savings. ED utilization following hepatopancreatic surgery remains poorly defined. We sought to define the rate of ED utilization following liver and pancreatic resection, as well as to identify factors associated with ED visits post-discharge.
The Medicare 100% Standard Analytic Files were used to identify Medicare beneficiaries who underwent hepatectomy or pancreatectomy between 2013 and 2017. Claims associated with ED services were identified using the relevant Revenue Center Codes. Patient characteristics and postoperative outcomes associated with ED care within 30 days of discharge were investigated.
Among 37,707 patients who underwent hepatopancreatic surgery, 10,323 (27.4%) had at least one ED visit within 30 days of discharge. Patients presenting to the ED were more likely to be male (OR 1.13, 95%CI 1.07-1.18). Patients undergoing a pancreatectomy (OR 1.39, 95%CI 1.32-1.47), as well as patients who had a perioperative complication (OR 1.16, 95%CI 1.10-1.23) and patients not discharged home (OR 1.41, 95%CI 1.33-1.49), were more likely to require ED care. In contrast, patients undergoing resection for cancer or surgery for an elective basis were less likely to present to the ED postoperatively (OR 0.92, 95%CI 0.87-0.97 and OR 0.22, 95%CI 0.20-0.23, respectively). Patients often had multiple ED visits within 30 days of discharge as 37.2% of patients presented to the ED with at least 2 visits. Visits were also most common in the immediate postoperative period, with 30.9% of ED visits taking place in the first 2 days from discharge. Among patients requiring postoperative ED care, 53.9% were readmitted within 30 days.
More than 1 in 4 patients undergoing hepatopancreatic surgery presented to the ED within 30 days of discharge, with most patients returning to the ED within the first week of discharge. A subset of patients had multiple ED visits. Future efforts should target patients most likely to be high ED utilizers to avoid the need for early post-discharge ED use.
医院急诊科（ED）提供的护理是节省成本的目标。肝胰手术后 ED 的利用情况仍未得到明确界定。我们旨在确定肝切除和胰腺切除术后 ED 就诊率，并确定与出院后 ED 就诊相关的因素。
使用 Medicare 100%标准分析文件确定 2013 年至 2017 年间接受肝切除术或胰腺切除术的 Medicare 受益人的数据。使用相关的收入中心代码识别与 ED 服务相关的索赔。调查了出院后 30 天内与 ED 护理相关的患者特征和术后结局。
在 37707 名接受肝胰手术的患者中，有 10323 名（27.4%）在出院后 30 天内至少有一次 ED 就诊。到 ED 就诊的患者更可能是男性（OR 1.13，95%CI 1.07-1.18）。接受胰腺切除术（OR 1.39，95%CI 1.32-1.47）、围手术期并发症（OR 1.16，95%CI 1.10-1.23）和未出院回家（OR 1.41，95%CI 1.33-1.49）的患者更有可能需要 ED 护理。相比之下，因癌症进行切除术或择期手术的患者术后到 ED 就诊的可能性较低（OR 0.92，95%CI 0.87-0.97 和 OR 0.22，95%CI 0.20-0.23）。患者经常在出院后 30 天内多次到 ED 就诊，因为 37.2%的患者至少就诊 2 次。就诊也最常见于术后即刻，出院后 2 天内有 30.9%的 ED 就诊。在需要术后 ED 护理的患者中，有 53.9%的患者在 30 天内再次入院。
超过四分之一的接受肝胰手术的患者在出院后 30 天内到 ED 就诊，大多数患者在出院后的第一周内再次到 ED 就诊。一部分患者有多次 ED 就诊。未来的工作应针对最有可能成为 ED 高使用者的患者，以避免出院后早期需要 ED 就诊。
