L. M. Pak1, M. A. Chaudhary1, N. K. Kwon1, T. P. Koehlmoos2, A. H. Haider1, A. J. Schoenfeld1 2Uniformed Services University Of The Health Sciences,Department Of Preventive Medicine,Bethesda, MD, USA 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA
Introduction: Post-discharge emergency department (ED) visits represent a significant clinical event for patients and are an important quality metric in healthcare. The national volume of lumbar spine surgeries has risen dramatically and represents an increasingly large proportion of healthcare costs. Quantifying the use of the ED post-discharge and identifying factors that increase ED utilization are critical in evaluating current hospital practices and addressing deficiencies in patient care.
Methods: This study utilized claims from patients insured through TRICARE, the insurance plan of the Department of Defense. TRICARE data was queried for the years 2006-2014 for patients aged 18-64 years old who had undergone one of three common lumbar spine surgery procedures (discectomy, spine decompression, spine fusion). Patient demographics, treatment characteristics, and follow-up information was abstracted from the claims data. Sponsor rank was used as a proxy for socio-economic status. Utilization of the ED at 30- and 90-days were the primary outcomes. Multivariable logistic regression tests were used to identify independent factors associated with 30- and 90-day ED utilization following a lumbar spine procedure.
Results: In the period under study, 48,485 patients met inclusion criteria. Fifteen percent of patients (n=7,183) presented to the ED within 30 days post-discharge. The 30-day readmission rate was 5% (n=2,344). By 90 days post-discharge, 30% of patients (n=14,388) presented to an ED. The 90-day readmission rate was 8% (n=3,842). The overall 30-day and 90-day complication rates were 6% (n=2,802) and 8% (n=4,034), respectively. Following multivariable testing, female sex, increased Charlson comorbidity index, lower socio-economic status, fusion-based spine procedures, length of stay, and complications were associated with ED utilization within 30- and 90-days (Table). Dependent beneficiary status was associated with 90-day ED utilization only (OR1.050, 95%CI 1.020-1.081).
Conclusion: Within 30- and 90-days after lumbar spine surgery, 15% and 30% of patients, respectively, sought care in the ED. However, only one-third of these patients had a complication recorded during the same period, and even fewer were subsequently readmitted. These findings suggest a high rate of unnecessary ED utilization. We have identified several characteristics associated with the risk of ED utilization, which may present viable targets for intervention in the peri-operative period.