Incidence, Predictors, and Outcomes of Emergency Surgery Following a Return Visit to the Emergency Department

Although return visits to the emergency department (ED) are well-studied, little is known about surgeries following these visits. We aimed to (1) estimate the incidence of surgery after a return ED visit, (2) identify factors associated with these events, and (3) compare outcomes between patients who received surgery after a return visit (revisit surgery) and those who underwent surgery during the initial visit (direct surgery).

This retrospective cohort study analyzed 454,330 adult ED visits at a tertiary medical center in Taiwan (2016-2019). We identified surgeries performed within 72 hours of an index ED visit and used logistic regression to analyze factors associated with these events. Inpatient outcomes, including mortality and hospital length of stay, were compared between revisit and direct surgery groups using logistic and median regression.

Of 454,330 visits, 4605 (1.0%) involved direct surgery during the initial visit. Among the 403,833 discharged patients, 16,776 (4.2%) returned to the ED within 3 days, and 196 (1.1%) underwent emergent surgery. Factors associated with revisit surgery included triage level, male sex, abdominal pain, older physician age, summer season, and time of presentation. Revisit surgery patients had similar inpatient mortality (adjusted odds ratio, 0.37; 95% CI, 0.09-1.54) and length of stay (adjusted difference, -0.38 days; 95% CI, -1.05 to 0.30) compared with the direct surgery group.

A small fraction (0.05%) of discharged patients required emergent surgery upon return. Identifying risk factors may help target at-risk populations, and outcomes did not differ significantly between revisit and direct surgery groups.