M. A. Chaudhary1, L. M. Pak1, D. Sturgeon1, T. P. Koehlmoos2, A. H. Haider1, A. J. Schoenfeld1 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Uniformed Services University Of The Health Sciences,Bethesda, MD, USA
Introduction:
Emergency department (ED) visits after elective surgical procedures are not only a significant quality of care indicator but also a potential target for interventions to reduce healthcare costs. With the volume of hip and knee arthroplasties soaring over 1 million annually, investigation of patterns of ED utilization in patients undergoing these procedures becomes critical. The objective of this study was to evaluate the patterns and predictors of 30- and 90-day ED utilization in a national sample of total hip arthroplasty (THR) and total knee arthroplasty (TKR) patients.
Methods:
The military health insurance database, TRICARE (2006-2014), was queried for patients aged 18-64 years who underwent THR and TKR. Patients demographics, clinical characteristics and environment of care information was abstracted. Sponsor rank was used as a proxy for socio-economic status. The outcome of interest was ED utilization. Multivariable logistic regression models were used to identify predictors of 30- and 90-day ED utilization.
Results:
Among the 44,557 patients included in the analysis, 14,187 (31.8%) underwent THR and 30,370 (68.2%) underwent TKR. Forty-nine percent and 70% patients received orthopedic outpatient care within 30- and 90- days after discharge respectively. The proportion of patients who presented to ED within 30 and 90 days were 24% and 35% respectively. The most common primary ICD-9 diagnoses associated with post-discharge ED visits were “Care involving other physical therapy” (V57.1) (17.6%), “Pain in joint” (719.46) (6.3%), “after care of joint replacement” (V54.81) (5.1%) and “encounter for therapeutic drug monitoring” (V58.83) (4.8%). In the risk adjusted analysis lower socio-economic status, LOS, comorbid conditions and complications were associated with higher odds of ED utilization, while orthopedic outpatient care was associated with lower odds of ED utilizations (Table).
Conclusion:
Almost one-third of the patients present to the ED within 90-days of THR and TKR. Lower socio-economic status, longer LOS, presence of comorbid conditions and complications were associated with increased ED visits; Whereas, orthopedic outpatient visits were associated with decreased ED visits. We concluded that appropriate outpatient care may reduce ED utilization after THR and TKR.
