Emergency Department Visits Following Patellofemoral Arthroplasty

Abstract

Background: Readmissions are a typical postoperative metric; however, postoperative emergency department (ED) utilization also negatively affects patient care. Few studies have explored this metric after patellofemoral arthroplasty (PFA); thus, we investigated the incidence, timing, predictive factors, and reasons for ED utilization within 90 days after PFA.

Methods: Using the 2010 to 2021 PearlDiver M151Ortho data set, a national billing claims database containing information of over 151 million US orthopaedic patients across all payer types, the study examined weekly ED visits up to 90 days after PFA and conducted univariate and multivariate analyses to identify predictive factors.

Results: Of 7765 PFA patients, 11.2% (922) had ED visits within 90 days, with 46.7% (431) occurring in the first 3 weeks. Independent predictors of ED utilization included younger age (OR 1.40 per decade decrease), higher Elixhauser Comorbidity Index (OR 1.44 per 2-point increase), surgery in the South or Midwest (OR 1.27 and 1.31), and Medicaid insurance (OR 1.74). Postoperative pain accounted for 50.6% of visits.

Conclusions: 11.2% of PFA patients visited the ED within 90 days, primarily for postoperative pain. Younger, more comorbid, and Medicaid-insured patients were most likely to use the ED. This study suggests the need for targeted perioperative pain management to reduce ED utilization after PFA.

Figure 1

Bar graph depicts the weekly incidence of emergency department (ED) visits after patellofemoral arthroplasty. Pie chart shows the breakdown of patients who visited versus did not visit the ED after surgery. The baseline for weekly ED visit incidence was calculated by averaging weekly visits between 52 and 56 weeks after total ankle arthroplasty.

Figure 2

Forest plot depicting results of multivariate analysis for independent predictive factors for emergency department (ED) utilization within 90 days of patellofemoral arthroplasty. Error bars represent 95% confidence intervals (CIs). Black bars indicate statistical significance (P < 0.05).

Figure 3

Bar graph and pie chart showing the most frequent primary diagnosis among patellofemoral arthroplasty patients who visited the emergency department (ED) within 90 days of surgery divided by relation to the surgical site.