Examining emergency department utilization in the post-foregut surgery patient

The purpose of this study was to examine emergency department (ED) utilization following minimally invasive foregut surgery and determine its impact on costs. Furthermore, we sought to determine their relationship to the index procedure, whether they are preventable, and describe strategies for decreasing unnecessary ED visits.

A retrospective review was conducted for all patients undergoing foregut procedures from January 2018 through June 2019. ED utilization was examined from 0 to 90 days. The proportion of visits related to surgery, preventable visits, and median ED costs were compared between visits occurring 0-30 days (early) versus 31-90 days (delayed) postoperatively as well as occurring from 8 am to 5 pm versus 5 pm to 8 am.

Of 458 patients who underwent foregut surgery, 72.5% were female and the mean age was 60 years old. 92 patients (20%) presented to the ED within 90 days. Of these, 59 patients (64.1%) presented to the ED early versus 33 patients (35.9%) delayed. 56.5% of ED visits occurred during clinic hours. 56 (60.9%) ED visits were related to the procedure and 20 (35.7%) were preventable. The median ED return cost was $970. Early ED visits were significantly more likely to be related to surgery (72.9% vs 39.4%, p = 0.0016). There was no significant difference in the proportion of visits that were preventable (32.6% vs 46.2%, p = 0.3755) and ED return cost did not vary significantly ($995 vs $965, p = 0.43) between early and delayed visits.

ED visits are common after foregut surgery and represent a financial burden on healthcare. Most visits occur early and are more likely to be related to surgery. Importantly, more than one-third of ED visits related to surgery were preventable and most occurred during clinic hours on weekdays. Providers should consider implementation of strategies to improve outpatient utilization and decrease unnecessary ED visits.