Preventable Emergency Department Visits After Colorectal Surgery.
Journal
Diseases of the colon and rectum
ISSN: 1530-0358
Titre abrégé: Dis Colon Rectum
Pays: United States
ID NLM: 0372764
Informations de publication
Date de publication:
01 11 2021
01 11 2021
Historique:
pubmed:
1
7
2021
medline:
4
1
2022
entrez:
30
6
2021
Statut:
ppublish
Résumé
The emergency department plays a common and critical role in the treatment of postoperative patients. However, many quality improvement databases fail to record these interactions. As such, our understanding of the prevalence and etiology of postoperative emergency department visits in contemporary colorectal surgery is limited. Visits with potentially preventable etiologies represent a significant target for quality improvement, particularly in the current era of rapidly evolving postoperative and ambulatory care patterns. We aimed to characterize postoperative emergency department visits and identify factors associated with these visits for potential intervention. This was a retrospective cohort study. The study was conducted at an academic medical center. Consecutive patients undergoing colectomy or proctectomy within the division of colorectal surgery at an academic medical center between 2014 and 2018 were included. Frequency and indication for emergency department visits, as well as clinical and sociodemographic factors associated with emergency department visits in the postoperative period, were included measures. From the 1763 individual operations, there were 207 emergency department visits from 199 patients (11%) within 30 days of discharge. Two thirds of emergency department visits led to readmission. Median (interquartile range) time to presentation was 8 days (4-16 d). Median time in the emergency department was 7.8 hours (6.0-10.1 h). One third of visits were identified as potentially preventable, most commonly for pain (17%) and stoma complications (excluding dehydration; 13%). A primary language other than English was associated with any postoperative emergency department visit risk ratio of 2.7 (95% CI, 1.3-5.3), as well as a preventable visit risk ratio of 3.6 (95% CI, 1.7-8.0). This was a single-center study and a retrospective review. One third of emergency department visits after colorectal surgery are potentially preventable. Special attention should be directed toward those patients who do not speak English as a primary language. See Video Abstract at http://links.lww.com/DCR/B648. ANTECEDENTES:Las unidades de emergencia tienen un rol fundamental en el periodo posterior a una cirugía. Sin embargo muchos de los registros en las bases de datos de estas secciones no son de buena calidad. Por esto analizar la prevalencia y etiología de las visitas postoperatorias en cirugía colorectal resulta ser bastante limitada. Para lograr una mejoría en la calidad es fundamental analizar las causas potencialmente evitables, especialmente al considerer la rapida evolucion de los parametros de medición actuales.OBJETIVO:Nuestro objetivo es caracterizar las visitas postoperatorias al servicio de urgencias e identificar los factores asociados potencialmente evitables.DISEÑO:Estudio de cohorte retrospectivo.AJUSTE:Centro médico académico, 2014-2018.PACIENTES:Pacientes consecutivos sometidos a colectomía o proctectomía dentro de la división de cirugía colorrectal en un centro médico académico entre 2014 y 2018.PRINCIPALES MEDIDAS DE RESULTADO:Frecuencia e indicación de las visitas al servicio de urgencias en el period postoperatorio: factores clínicos y sociodemográficos.RESULTADOS:De 1763 operaciones individuales, hubo 207 visitas al departamento de emergencias de 199 pacientes (11%) en los 30 días posteriores al alta. Dos tercios de las visitas al servicio de urgencias dieron lugar a readmisiones. La mediana [rango intercuartílico] de tiempo hasta la presentación fue de 8 [4-16] días. La mediana de tiempo en el servicio de urgencias fue de 7,8 [6-10,1] horas. Un tercio de las visitas se identificaron como potencialmente evitables, más comúnmente dolor (17%) y complicaciones del estoma (excluida la deshidratación) (13%). En los pacientes con poco manejo del inglés se asoció con una mayor frecuencia razón de visitas al departamento de emergencias posoperatorias [IC del 95%] 2,7 [1,3-5,3], así como opetancialmente evitables con un RR de 3,6 [1,7-8,0].LIMITACIONES:Estudio de un solo centro y revisión retrospectiva.CONCLUSIÓN:Al menos un tercio de las visitas al servicio de urgencias después de una cirugía colorrectal son potencialmente evitables. Se debe prestar especial atención a los pacientes que no hablan inglés como idioma materno. Consulte Video Resumen en http://links.lww.com/DCR/B648.
Sections du résumé
BACKGROUND
The emergency department plays a common and critical role in the treatment of postoperative patients. However, many quality improvement databases fail to record these interactions. As such, our understanding of the prevalence and etiology of postoperative emergency department visits in contemporary colorectal surgery is limited. Visits with potentially preventable etiologies represent a significant target for quality improvement, particularly in the current era of rapidly evolving postoperative and ambulatory care patterns.
OBJECTIVE
We aimed to characterize postoperative emergency department visits and identify factors associated with these visits for potential intervention.
DESIGN
This was a retrospective cohort study.
SETTINGS
The study was conducted at an academic medical center.
PATIENTS
Consecutive patients undergoing colectomy or proctectomy within the division of colorectal surgery at an academic medical center between 2014 and 2018 were included.
MAIN OUTCOME MEASURES
Frequency and indication for emergency department visits, as well as clinical and sociodemographic factors associated with emergency department visits in the postoperative period, were included measures.
RESULTS
From the 1763 individual operations, there were 207 emergency department visits from 199 patients (11%) within 30 days of discharge. Two thirds of emergency department visits led to readmission. Median (interquartile range) time to presentation was 8 days (4-16 d). Median time in the emergency department was 7.8 hours (6.0-10.1 h). One third of visits were identified as potentially preventable, most commonly for pain (17%) and stoma complications (excluding dehydration; 13%). A primary language other than English was associated with any postoperative emergency department visit risk ratio of 2.7 (95% CI, 1.3-5.3), as well as a preventable visit risk ratio of 3.6 (95% CI, 1.7-8.0).
LIMITATIONS
This was a single-center study and a retrospective review.
CONCLUSIONS
One third of emergency department visits after colorectal surgery are potentially preventable. Special attention should be directed toward those patients who do not speak English as a primary language. See Video Abstract at http://links.lww.com/DCR/B648.
SE PUEDEN EVITAR LAS VISITAS AL SERVICIO DE URGENCIA DESPUS DE UNA CIRUGA COLORECTAL
ANTECEDENTES:Las unidades de emergencia tienen un rol fundamental en el periodo posterior a una cirugía. Sin embargo muchos de los registros en las bases de datos de estas secciones no son de buena calidad. Por esto analizar la prevalencia y etiología de las visitas postoperatorias en cirugía colorectal resulta ser bastante limitada. Para lograr una mejoría en la calidad es fundamental analizar las causas potencialmente evitables, especialmente al considerer la rapida evolucion de los parametros de medición actuales.OBJETIVO:Nuestro objetivo es caracterizar las visitas postoperatorias al servicio de urgencias e identificar los factores asociados potencialmente evitables.DISEÑO:Estudio de cohorte retrospectivo.AJUSTE:Centro médico académico, 2014-2018.PACIENTES:Pacientes consecutivos sometidos a colectomía o proctectomía dentro de la división de cirugía colorrectal en un centro médico académico entre 2014 y 2018.PRINCIPALES MEDIDAS DE RESULTADO:Frecuencia e indicación de las visitas al servicio de urgencias en el period postoperatorio: factores clínicos y sociodemográficos.RESULTADOS:De 1763 operaciones individuales, hubo 207 visitas al departamento de emergencias de 199 pacientes (11%) en los 30 días posteriores al alta. Dos tercios de las visitas al servicio de urgencias dieron lugar a readmisiones. La mediana [rango intercuartílico] de tiempo hasta la presentación fue de 8 [4-16] días. La mediana de tiempo en el servicio de urgencias fue de 7,8 [6-10,1] horas. Un tercio de las visitas se identificaron como potencialmente evitables, más comúnmente dolor (17%) y complicaciones del estoma (excluida la deshidratación) (13%). En los pacientes con poco manejo del inglés se asoció con una mayor frecuencia razón de visitas al departamento de emergencias posoperatorias [IC del 95%] 2,7 [1,3-5,3], así como opetancialmente evitables con un RR de 3,6 [1,7-8,0].LIMITACIONES:Estudio de un solo centro y revisión retrospectiva.CONCLUSIÓN:Al menos un tercio de las visitas al servicio de urgencias después de una cirugía colorrectal son potencialmente evitables. Se debe prestar especial atención a los pacientes que no hablan inglés como idioma materno. Consulte Video Resumen en http://links.lww.com/DCR/B648.
Identifiants
pubmed: 34192709
doi: 10.1097/DCR.0000000000002127
pii: 00003453-202111000-00015
pmc: PMC8519030
mid: NIHMS1717095
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1417-1425Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL007734
Pays : United States
Informations de copyright
Copyright © The ASCRS 2021.
Références
Weinick RM, Burns RM, Mehrotra A. Many emergency department visits could be managed at urgent care centers and retail clinics. Health Aff (Millwood). 2010;29:1630–1636.
Wood T, Aarts MA, Okrainec A, et aliERAS group. Emergency room visits and readmissions following implementation of an enhanced recovery after surgery (iERAS) program. J Gastrointest Surg. 2018;22:259–266.
Moore BJ, Stocks C, Owens PL. Trends in Emergency Department Visits, 2006-2014. Statistical Brief #227. 2017. Vol 96. Accessed January 28, 2020. www.hcup-us.ahrq.gov/reports/statbriefs/sb227-Emergency-Department-Visit-Trends.pdf
Kocher KE, Nallamothu BK, Birkmeyer JD, Dimick JB. Emergency department visits after surgery are common for Medicare patients, suggesting opportunities to improve care. Health Aff (Millwood). 2013;32:1600–1607.
Ibrahim AM, Nathan H, Thumma JR, Dimick JB. Impact of the hospital readmission reduction program on surgical readmissions among medicare beneficiaries. Ann Surg. 2017;266:617–624.
Merkow RP, Ju MH, Chung JW, et al. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA. 2015;313:483–495.
Bliss LA, Maguire LH, Chau Z, et al. Readmission after resections of the colon and rectum: predictors of a costly and common outcome. Dis Colon Rectum. 2015;58:1164–1173.
Liu VX, Rosas E, Hwang J, et al. Enhanced recovery after surgery program implementation in 2 surgical populations in an integrated health care delivery system. JAMA Surg. 2017;152:e171032.
Nagle D, Pare T, Keenan E, Marcet K, Tizio S, Poylin V. Ileostomy pathway virtually eliminates readmissions for dehydration in new ostomates. Dis Colon Rectum. 2012;55:1266–1272.
Parrish AB, O’Neill SM, Crain SR, et al. An enhanced recovery after surgery (ERAS) protocol for ambulatory anorectal surgery reduced postoperative pain and unplanned returns to care after discharge. World J Surg. 2018;42:1929–1938.
Hendren S, Vu J, Suwanabol P, Kamdar N, Hardiman K. Hospital variation in readmissions and visits to the emergency department following ileostomy surgery. J Gastrointest Surg. 2020;24:2602–2612.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.
Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. New 5-factor modified frailty index using American College of Surgeons NSQIP data. J Am Coll Surg. 2018;226:173–181.e8.
Symer MM, Abelson JS, Milsom J, McClure B, Yeo HL. A mobile health application to track patients after gastrointestinal surgery: results from a pilot study. J Gastrointest Surg. 2017;21:1500–1505.
Tatar C, Benlice C, Delaney CP, et al. Modified frailty index predicts high-risk patients for readmission after colorectal surgery for cancer. Am J Surg. 2020;220:187–190.
Hyde LZ, Al-Mazrou AM, Kuritzkes BA, Suradkar K, Valizadeh N, Kiran RP. Readmissions after colorectal surgery: not all are equal. Int J Colorectal Dis. 2018;33:1667–1674.
Berkowitz SA, Traore CY, Singer DE, Atlas SJ. Evaluating area-based socioeconomic status indicators for monitoring disparities within health care systems: results from a primary care network. Health Serv Res. 2015;50:398–417.
Gallagher RA, Porter S, Monuteaux MC, Stack AM. Unscheduled return visits to the emergency department: the impact of language. Pediatr Emerg Care. 2013;29:579–583.
Karliner LS, Auerbach A, Nápoles A, Schillinger D, Nickleach D, Pérez-Stable EJ. Language barriers and understanding of hospital discharge instructions. Med Care. 2012;50:283–289.
Inagaki E, Farber A, Kalish J, et al. Role of language discordance in complication and readmission rate after infrainguinal bypass. J Vasc Surg. 2017;66:1473–1478.
Feeney T, Sanchez SE, Tripodis Y, et al. The association of primary language with emergency general surgery outcomes using a statewide database. J Surg Res. 2019;244:484–491.
Bray BD, Steventon A. What have we learnt after 15 years of research into the ‘weekend effect’? BMJ Qual Saf. 2017;26:607–610.
Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152:292–298.
Regenbogen SE, Read TE, Roberts PL, Marcello PW, Schoetz DJ, Ricciardi R. Urinary tract infection after colon and rectal resections: more common than predicted by risk-adjustment models. J Am Coll Surg. 2011;213:784–792.
Nikolian VC, Williams AM, Jacobs BN, et al. Pilot study to evaluate the safety, feasibility, and financial implications of a postoperative telemedicine program. Ann Surg. 2018;268:700–707.
Dawes AJ, Sacks GD, Russell MM, et al. Preventable readmissions to surgical services: lessons learned and targets for improvement. J Am Coll Surg. 2014;219:382–389.
Zafar SN, Shah AA, Channa H, Raoof M, Wilson L, Wasif N. Comparison of rates and outcomes of readmission to index vs nonindex hospitals after major cancer surgery. JAMA Surg. 2018;153:719–727.