Early Emergency Department Visits are a Predictor of Increased Health Care Utilization Within 1 Year After Elective...

Retrospective cohort study.

The purpose of this study is to determine the incidence of and risk factors for emergency department (ED) utilization following elective spine surgery and to quantify health care utilization in this subpopulation of patients.

The Centers for Medicare and Medicaid Services (CMS) imposes financial penalties for unplanned 30-day hospital readmissions following the surgery. Determining predictive factors of hospital readmission and further health care utilization is a concern aligned with the values of both payers and providers to better improve patient outcomes.

A total of 618 patients who underwent elective spine surgery between 2013 and 2018 at a single academic institution were identified. Demographic and surgical variables were compared between patients with and without 90-day ED visits. After propensity score matching, univariate analysis and binary logistic regression were used to identify risk factors for 90-day ED visits and compare health care utilization between groups.

Of the 618 included patients, 44 (7.1%) had a 90-day ED visit. Patients with ED visits were more likely to have class II obesity (P=0.043), diabetes (P=0.013), congestive heart failure (P=0.006), and a history of myocardial infarction (P=0.027). Independent risk factors were obesity, diabetes, congestive heart failure, history of myocardial infarction, and preoperative opioid use. Patients with a 90-day ED visit had increased health care utilization within 1 year postoperatively, including: more MRI studies (P=0.044), repeat ED visits (P=0.033), more urgent care visits (P=0.007), and opioid prescriptions (P=0.043).

While only ∼7% of patients visit the ED within 90 days of spine surgery, various patient-specific factors were predictive of this. As these patients are more likely to be high health care utilizers, attention should be garnered toward preoperative patient optimization.