Purpose
Emergency department (ED) visits for postoperative concerns that could be safely addressed
in outpatient clinics have an impact on cost, quality measures, and care workflows.
Patient-reported data (PRD) may give unique insights into individual-level factors
that predict overuse of health care resources, and guide opportunities for intervention
and prevention. We investigated the relationship between preoperative PRD and preventable
ED use after outpatient hand surgery to determine whether the preoperative PRD can
be used to identify patients at higher odds of having preventable ED visits.
Methods
All adult patients undergoing outpatient surgery at our hand center between January
1, 2018, and December 31, 2019, were included. Questionnaires, including the Patient-Reported
Outcomes Measurement Information System (PROMIS) upper extremity (UE) and pain interference
(PI) scales, were completed before surgery. We used our regional health information
exchange to identify ED visits within 90 days of surgery.
Results
Our cohort included 2,819 patients. Within 90 days after surgery, 106 (3.8%) had preventable
ED visits. Race, insurance status, and transportation issues increased odds of a preventable
ED visit. Multivariable models found that each 1-point increase in the preoperative
PROMIS UE score was associated with 4% decreased odds of ED presentation (odds ratio,
0.96; 95% confidence interval, 0.94–0.99), and each 1-point increase in the preoperative
PROMIS PI score was associated with 4% increased odds of ED presentation (odds ratio,
1.04; 95% confidence interval, 1.0–1.1). Any PROMIS UE or PI scores ≥1SDs worse than
population norms increased the probability of a preventable ED visit, independent
of other factors.
Conclusions
Worse preoperative PROMIS UE and PI scores were associated with increased odds of
preventable ED visits. Preoperative PRD may allow for identification of outliers at
higher risk for preventable ED use, and facilitate preventative interventions.
Type of study/level of evidence
Prognostic IV.
Key words
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Article info
Publication history
Published online: July 15, 2022
Accepted:
May 18,
2022
Received:
December 2,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
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