ED visits within 90 days of spine surgery linked with increased health care utilization
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CHICAGO — There was significantly increased use of imaging, urgent care visits, added ED visits and cumulative opioid prescriptions after spine surgery among patients who had an ED visit within 90 days of surgery, study results showed.
At the American Academy of Orthopaedic Surgeons Annual Meeting, Erik Gerlach, MD, discussed results of a retrospective analysis he and his colleagues performed to study ED visits and health care utilization at 90 days and 1 year after spine surgery among 623 patients treated at their institution.
“Patients with a 90-day ED visit had significantly increased health care utilization within 1 year,” he said.
“We found that 8.2% of the patients had an ED visit within 90 days of surgery,” Gerlach said, noting 25.5% of these visits resulted in a hospital admission and about 17% of the patients who were hospitalized presented to the ED multiple times within 90 days of spine surgery.
In the 90-day postoperative period, Gerlach said, “the most common reasons for ED visits were medical complications at 41%, pain at 29% and incision concerns at 16%.”
Results showed class 2 obesity, an American Society of Anesthesiology score of 3 or more, a Charlson Comorbidity Index greater than 1, diabetes, myocardial infarction (MI) and congestive heart failure were more likely among patients with ED visits within 90 days of surgery.
“Additionally, univariate analysis found the same variables to be associated with an ED visit within 90 days except for having a history of MI,” Gerlach said.
“Prior to propensity score matching, patients with a 90-day ED visit were more likely to have higher rates of health care utilization the first year following surgery,” he said.
Additional ED visits after 90 days, greater use of CT and MRI imaging studies, more urgent care visits and more opioid prescriptions constituted most of the health care utilization among these patients within the first postoperative year, according to Gerlach.
Following propensity matching, patients with a 90-day ED visit “experienced a greater number of additional ED visits after 90 days, more urgent care visits and more opioid prescriptions at 1 year,” he said.
Gerlach said other key variables, such as cost of ED visits, social determinants of health and insurance status, were not accounted for in the study and limited the findings.
“Future research should include prospective studies that aim to risk stratify patients based on patient and surgical variables and baseline patient-reported outcomes,” Gerlach said.
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Gerlach E, et al. Paper 377. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 22-26, 2022; Chicago.
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