Incidence, Risk Factors, and Reasons for Emergency Department Utilization 90 Days After Achilles Tendon Repair

Area of Science:

• Orthopedic Surgery
• Health Services Research

Background:

• Postoperative emergency department (ED) utilization negatively impacts patient satisfaction and escalates healthcare expenditures.
• Understanding patterns of ED visits after Achilles tendon repair (ATR) is crucial for improving patient outcomes and managing costs.

Purpose of the Study:

• To determine the incidence, identify risk factors, and ascertain the primary reasons for emergency department (ED) visits within 90 days following Achilles tendon repair (ATR).

Main Methods:

• A retrospective case-control study utilizing the PearlDiver database to analyze 82,604 primary ATR cases.
• Extracted data included patient demographics, Elixhauser Comorbidity Index (ECI), insurance status, and ED visit details (timing, diagnoses).
• Statistical analyses involved Welch t-tests, Pearson chi-square tests, and multivariable logistic regressions to identify risk factors and compare costs.

Main Results:

• 8.4% of patients experienced at least one ED visit within 90 days of ATR, with over half occurring within the first four weeks.
• ED visits significantly increased mean 90-day costs ($7330 vs $3515; P < .001).
• Independent risk factors for ED utilization included younger age, female sex, higher ECI, tobacco use, and Medicaid insurance. Surgical site pain was the predominant reason for visits, especially within the first two weeks.

Conclusions:

• A significant proportion of patients undergoing ATR utilize ED services postoperatively, incurring substantial additional healthcare costs.
• Targeted interventions focusing on pain management, addressing socioeconomic factors (e.g., insurance), and enhancing perioperative care are recommended to mitigate ED visits and associated expenses.