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Medium and long-term emergency department utilization after oesophagectomy: a population-based analysis
Biniam Kidane1,2, Binu Jacob3, Vaibhav Gupta2
1Section of Thoracic Surgery, University of Manitoba, Winnipeg, MB, Canada.
Summary
Emergency department visits are common after oesophagectomy, with over half of patients experiencing at least one visit within a year. Higher comorbidity, rurality, and receiving chemotherapy/radiation increase risk for frequent emergency department use.
Area of Science:
- Surgical Outcomes Research
- Healthcare Resource Utilization
- Oncology Patient Management
Background:
- Oesophagectomy is a complex surgical procedure associated with prolonged recovery periods.
- Understanding post-operative healthcare resource utilization is crucial for optimizing patient care and system efficiency.
Purpose of the Study:
- To evaluate healthcare resource utilization, specifically emergency department (ED) visits within one year of oesophagectomy.
- To identify independent risk factors associated with ED visits and frequent ED use (FEDU) after oesophagectomy.
Main Methods:
- A retrospective cohort study analyzed linked health data from all Ontario hospitals between 2000 and 2012.
- Data included 3344 oesophagectomies for cancer, with multivariable regression used to identify factors associated with ED visits and FEDU (≥3 visits within 1 year).
Main Results:
- Over 55% of patients had at least one ED visit within one year post-oesophagectomy; 24.3% experienced frequent ED use (≥3 visits).
- Independent risk factors for ED visits and FEDU included higher comorbidity, rural residence, and receipt of chemotherapy/radiation therapy.
- Thoracoscopic-assisted surgery was associated with decreased ED visits, while certain health regions and later study years showed increased ED utilization.
Conclusions:
- Emergency department visits are a significant concern following oesophagectomy, affecting over half of patients within a year.
- Identified demographic, surgical, and regional factors provide targets for quality improvement initiatives to reduce post-operative ED utilization.
- Further research into optimizing care pathways for oesophagectomy patients, particularly those with identified risk factors, is warranted.
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