Emergency department utilization after elbow arthroscopy

Elbow arthroscopy has defined indications for which technical pearls and outcomes have been described. However, other aspects of the postoperative course, such as postprocedural emergency department (ED) visits, have received less attention. The current study defined the incidence and factors associated with ED visits in the 90 days following elbow arthroscopy by leveraging a large, national, multiinsurance, administrative database.

Adult patients who underwent elective elbow arthroscopy were identified in the 2010 to Q1 2022 PearlDiver Mariner161 national administrative database. Those who visited the ED in the 90 days following surgery were identified and compared to those who did not based on age, sex, Elixhauser Comorbidity Index, geographic region of the United States, and insurance type by multivariate analyses. The timing (weeks following surgery), reasons for ED visit (elbow-related or not), and ED-to-hospital admission (presence or absence) were also assessed. Finally, the rate of those who were admitted during an ED visit was described.

A total of 16,310 elbow arthroscopy patients were identified, of which ED visits in the 90 days following surgery were noted for 1086 (6.7%). ED visits were independently associated with younger age (odds ratio [OR, 95% confidence interval (CI)]: 1.23 [1.17, 1.29] per decade decrease), higher Elixhauser Comorbidity Index (OR [95% CI]: 1.21 [1.19, 1.23] per 1-point increase), different geographic region (OR [95% CI]: 1.42 [1.19, 1.71] for Midwest relative to West), and insurance (OR [95% CI]: 1.88 [1.48, 2.39] for Medicaid relative to Commercial) (P < .001 for each). The incidence of all-cause ED visits was highest during the first two postoperative weeks and gradually decreased over the following weeks. The reason for ED visits related to the elbow decreased from 65% in month one, to 37.7% in month two, to 26.6% in month three. Of those visiting the ED, 12.4% went on to be admitted (for any reason).

A significant proportion of patients from a large cohort of elbow arthroscopy patients visited the ED at least once in the 90 days following surgery. The defined associated factors and timing of these ED visits can help optimize postoperative care pathways.