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Variables associated with pediatric emergency department visits for uncontrolled pain in postoperative
Jennifer Lavin1, David Lehmann2, Astrid Leon Silva3
1Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA.
Insights
Post-tonsillectomy (T&A) emergency department (ED) returns are linked to Hispanic ethnicity and postoperative phone calls. Many patients returning to the ED were not adherent with pain regimens, highlighting a need for adherence assessment.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Services Research
Background:
- Adenotonsillectomy (T&A) is a common pediatric procedure.
- Emergency department (ED) returns for pain or dehydration post-T&A are frequent.
- Previous studies have not identified specific pain regimens associated with these returns.
Purpose of the Study:
- To identify factors associated with ED returns after T&A.
- To investigate the role of patient demographics, comorbidities, and postoperative communication in ED readmissions.
- To assess medication adherence in patients returning to the ED.
Main Methods:
- A 2:1 matched cohort study compared patients who returned to the ED post-T&A with those who did not.
- Data collected included patient demographics, comorbidities, medication regimens, and postoperative telephone encounters.
- Medication adherence was assessed for patients who returned to the ED.
Main Results:
- 1.9% of 7493 T&A patients returned to the ED for pain/dehydration.
- ED returns were associated with Hispanic ethnicity, Spanish language, Down syndrome, ADHD, and parent phone calls.
- Multivariable analysis confirmed Hispanic ethnicity and phone calls as significant predictors of ED returns.
- Only 64% of ED return patients were adherent to pain regimens.
Conclusions:
- Demographic factors and postoperative phone calls are associated with ED returns post-T&A.
- Postoperative phone calls demonstrated the strongest association with ED returns.
- Non-adherence to pain medication is prevalent among patients returning to the ED, indicating a potential area for intervention.
Objective:
Returns to the emergency department (ED) for pain or dehydration after adenotonsillectomy (T&A) are frequent. Attempts to associate the specific pain regimens with these visits have been unrevealing, suggesting a need to assess for other potential factors associated with readmission.
Methods:
A review of a 2:1 cohort matched by age, gender and payer status compared post-T&A patients who did not return ED for pain or dehydration within 21 days to those who returned. Factors investigated included patient demographics, comorbidities, medication regimen and the presence of postoperative telephone encounters. Patients returning to the ED were further assessed for rates of medication adherence.
Results:
7493 patients underwent T&A during the period. Of these, 144 (1.9%) returned for pain/dehydration. Comparison to 285 matched patients revealed an association between ED returns and Hispanic ethnicity (p < 0.001), Spanish language (p = 0.0002), and comorbid Down syndrome and ADHD (p = 0.011 in both). The incidence of parent telephone calls to the office was associated with ED returns (58.7 in the ED cohort, 28.4% in non-ED cohort, p < 0.0001). On multivariable analysis, Hispanic ethnicity and phone calls were associated with ED returns (p < 0.0001 and p < 0.0001, respectively). Only 64.0% of patients returning to the ED were adherent with postoperative pain regimens.
Conclusions:
While demographic factors may be associated with rate of ED returns for pain and dehydration, post-operative phone calls were most highly associated with returns. The majority of patients returning to the ED were non-adherent with recommended pain regimens, suggesting an opportunity to investigate medication adherence in all post-tonsillectomy patients.
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