Trends in emergency department utilization following common operations in New York State, 2005-2014

Abstract

Background: ED overutilization is a leading cause of increased healthcare costs and a key target for healthcare reform. ED utilization patterns following common operative procedures are unknown.

Methods: Using the SPARCS New York (NY) statewide longitudinal administrative database, a longitudinal analysis on 746,633 patients who underwent cholecystectomy (n = 355,368), appendectomy (n = 142,797) or inguinal hernia repair (n = 248,468) from 2005 to 2014 was performed. ED revisits were identified via unique patient identifiers which allow for patient tracking across hospitals in NY State.

Results: In total, 59,255 (7.9%) patients presented to the ED within 30-days of their operation of which 21,638 (36.5%) were admitted. The aggregated rate of ED utilization and admission from the ED were as follows: cholecystectomy (9.5%, 40%), appendectomy (9.1%, 33.1%), and inguinal hernia repair (5.1%, 26.2%), respectively. A longitudinal analysis demonstrated a relative slowing of the rate of increase in hospital readmissions for cholecystectomy and inguinal hernia repair but no change in the number of ED revisits for inguinal hernia repair.

Conclusions: Nearly 1 in 10 patients undergoing cholecystectomy and appendectomy, and 1 in 20 patients undergoing inguinal hernia repair will present to the ED following surgery. The majority of ED visits do not result in admission, calling their necessity into question. These data suggest possible overutilization of the ED following common operations and support the consideration of ED utilization as a quality indicator.

Keywords: Admission; Complication; Emergency Department; Healthcare costs; Utilization.

Figure 1.. ED Utilization and visit outcomes.

ED Revisit Rate, ED Readmission Rate, and ED Discharge Rate are shown as percentages for the overall cohort as well as for each of three procedures individually.

Figure 2.. Proportion of ED Revisit resulting in discharge by specific procedure type.

ED Discharge Rate are shown as percentage of total patients undergoing all three operations combined as well as each specific procedure (cholecystectomy, appendectomy, and inguinal hernia repair) individually.

Figure 3.. ED revisit rates and admission rates from 2005–2014.

Rates (%) of hospital readmission and ED visits for the three surgical procedures. There are two lines in each plot: the annual rates estimated by Poisson regression (darker); and the predicted rates under the counterfactual assumption holding true estimated 2005–2009 rates (lighter).