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Study: Almost 20% of Medicare patients visit ED after surgery

Tuesday September 10, 2013
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Nearly one in five older adults who undergo common operations will end up in the ED within a month of their hospital stay, according to a study described as the first national look at the issue.

Some hospitals had four times the rate of post-surgery emergency care for their patients when compared with other hospitals, reported researchers with the University of Michigan Medical School.

The findings, published in the September issue of Health Affairs, come from an analysis of Medicare data of nearly 2.4 million adults who had at least one of six common operations during a three-year period. Among the study pool, 17.3% experienced at least one ED visit within the postdischarge period and 4.4% had multiple ED visits.

More than half the patients who sought emergency care ended up being readmitted to the hospital directly from the ED.

Keith Kocher, MD, an emergency physician and an assistant professor in the Department of Emergency Medicine at the U-M Medical School, and colleagues studied post-hospital emergency care and hospitalizations among seniors who had one or more of six of the most common operations: angioplasty or other minimally invasive heart procedures, coronary artery bypass, hip fracture repair, back surgery, elective abdominal aortic aneurysm repair, and colectomy.

The most common issues that brought patients to the ED were cardiovascular and respiratory conditions, infections, complications with the site of their surgery or procedure incision, and abdominal or gastrointestinal problems.

“There was a lot of variation depending on what the surgery was for,” Kocher said in a news release, adding that for colon surgery, the rate of post-hospital emergency visits ranged from one in four patients treated at some hospitals to one in 14 treated at others.

“We went into this expecting some variation, but were surprised at how much we found. 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.”

In addition to an opportunity for surgical and inpatient teams to do a better job at educating patients and managing their care in the first days after they go home, Kocher and his colleagues see a potential role for emergency clinicians in reducing rates of post-surgery ED visits.

“An emergency visit by a surgical patient is a signifier of a problem in the transition from the hospital to the outpatient setting,” he said. “Emergency visits by post-surgery patients could be used to re-establish coordination of care, as well as deliver treatment and create management plans to prevent readmission.”

Hospitals could be graded based on their performance relating to ED use after surgery, the researchers suggested, but further study is needed before such a measure would join hospital readmissions and infection rates as examples of established quality indicators.

Study abstract: http://content.healthaffairs.org/content/32/9/1600.abstract.


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