门诊择期肩袖修复术后急诊科利用率较低。
Emergency Department Utilization Is Low After Outpatient Elective Rotator Cuff Repair.
机构信息
From the University Hospitals Cleveland Medical Center, Cleveland, OH (Raji, Vakharia, Sivasundaram, Salata, Voos, and Gillespie), the Case Western Reserve University School of Medicine, Cleveland, OH (Chen, Salata, Voos, and Gillespie), the Cleveland Clinic Foundation, Cleveland, OH (Wang), and the University Hospitals Cleveland, Sports Medicine Institute, Cleveland, OH (Salata, Voos, and Gillespie).
出版信息
J Am Acad Orthop Surg. 2022 Mar 1;30(5):e547-e560. doi: 10.5435/JAAOS-D-21-00890.
INTRODUCTION
The purpose of this study was to establish emergency department (ED) utilization rate and reasons for presentation to the ED after outpatient rotator cuff repair (RCR) and determine preoperative predictors for these ED visits.
METHODS
Patients who underwent outpatient RCR between 2014 and 2015 were retrospectively evaluated using the New York and Florida State Databases. The primary outcome was all-cause 7- and 30-day ED utilization rates. Reasons for presentation to the ED were recorded and stratified. Univariate and multivariate analyses were done to identify independent predictors of ED utilization.
RESULTS
The 7- and 30-day ED visit rates were 3.2% and 5.0%, respectively. The most common cause for an ED visit after outpatient RCR at 7- and 30-days postoperatively were postoperative pain (29.0%) and GI complaints (16.3%), respectively. African American race (odds ratio [OD], 1.69; P < 0.001), Hispanic race (OD, 1.47; P = 0.005), and comorbid diagnoses of hypertension (OD, 1.51; P < 0.001), diabetes (OD, 1.58; P < 0.001), and/or schizophrenia (OD, 5.14; P < 0.001) were independent risk factors for an ED visit at up to 30 days postoperatively. Those with Medicare (OD, 2.01; P < 0.001) or Medicaid (OD, 2.61; P < 0.001) were more than twice as likely to present to the ED within 30 days than those with private health insurance.
DISCUSSION
ED utilization after outpatient RCR is uncommon with postoperative pain as the most common chief concern for ED visits within the first 7 days and GI issues as the most common reason for ED encounters at up to 30 days postoperatively. Hypertension, diabetes, renal failure, liver disease, rheumatologic diseases, schizophrenia, depression, and Medicare and Medicaid insurance were independent predictors of ED encounters at up to 30 days postoperatively. Procedures done at freestanding surgery centers were protective against ED utilization.
LEVEL OF EVIDENCE
Level III, Retrospective Cohort.
简介
本研究的目的是确定行门诊肩袖修补术（RCR）后的患者在术后 7 天和 30 天内前往急诊部（ED）就诊的使用率和原因，并确定这些 ED 就诊的术前预测因素。
方法
使用纽约和佛罗里达州数据库对 2014 年至 2015 年间行门诊 RCR 的患者进行回顾性评估。主要结局是所有原因的 7 天和 30 天 ED 使用率。记录并分层记录就诊原因。进行单变量和多变量分析以确定 ED 使用率的独立预测因素。
结果
7 天和 30 天 ED 就诊率分别为 3.2%和 5.0%。术后 7 天和 30 天门诊 RCR 后最常见的 ED 就诊原因是术后疼痛（29.0%）和胃肠道不适（16.3%）。非裔美国人（优势比[OR]，1.69；P < 0.001）、西班牙裔（OR，1.47；P = 0.005）和合并高血压（OR，1.51；P < 0.001）、糖尿病（OR，1.58；P < 0.001）和/或精神分裂症（OR，5.14；P < 0.001）的合并症诊断是术后 30 天内 ED 就诊的独立危险因素。有医疗保险（OR，2.01；P < 0.001）或医疗补助（OR，2.61；P < 0.001）的患者在 30 天内就诊的可能性是私人健康保险的两倍以上。
讨论
门诊 RCR 后 ED 的使用率较低，术后疼痛是术后 7 天内 ED 就诊的最常见主诉，胃肠道问题是术后 30 天内 ED 就诊的最常见原因。高血压、糖尿病、肾衰竭、肝病、风湿性疾病、精神分裂症、抑郁症以及医疗保险和医疗补助是术后 30 天内 ED 就诊的独立预测因素。在独立的手术中心进行的手术可以预防 ED 的使用。
证据水平
III 级，回顾性队列。
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