Postsurgical Emergency Room Visits Surprisingly High

The researchers reviewed post-hospital emergency care and hospitalizations among seniors who had one or more of six common operations: angioplasty or other minimally invasive heart procedures, coronary artery bypass, hip fracture repair, back surgery, elective abdominal aortic aneurysm repair, and colectomy or removal of part of the colon, such as for colon cancer.

The results showed that ED visits were widespread, with 17.3% of these patients experiencing at least one ED visit within the post-discharge period, and 4.4% of the patients with multiple ED visits. Among those patients who were readmitted to the hospital, 56.5% were readmitted from the ED. The researchers also found that there was substantial variation—as much as fourfold—in hospital-level ED use for these patients, across all six procedures. According to the researchers, the variation might signify a failure in upstream coordination of care, and could therefore represent a novel hospital quality indicator. The study was published in the September 2013 issue of Health Affairs.

“There was a lot of variation depending on what the surgery was for; we went into this expecting some variation, but were surprised at how much we found,” said lead author Keith Kocher, MD. “That means, this is probably a finding health providers and systems can act on to improve their rates, to ensure coordination of care, and that patients can access timely care for problems that develop after they are discharged before having to come to the ED.”

“Integrating care across all settings might help hospitals reduce their postsurgery emergency care rate, and as readmission penalties mount, hospitals may begin to focus more on emergency physicians' decision-making process regarding readmitting a patient from the ED,” added Dr. Kocher. “Further research on the reasons for these emergency visits, the impact of hospital-discharge education and planning on postsurgery ED visits, and the reasons why emergency patients are readmitted from the emergency department is needed. Social and family support reasons, not just medical considerations, may play a big role.”

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