Characterizing prior symptomatic emergency department visits among patients undergoing unplanned colon cancer surgery

Among patients who have undergone unplanned cancer surgery, what is the prevalence and demographic distribution of antecedent symptomatic emergency department visits that occurred without documented diagnostic follow-up, and what patient- and hospital-level characteristics are associated with having had such visits.

Retrospective observational cohort study.

Arkansas, Florida, Maryland, New York, and Wisconsin 2016-2021 Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases.

Patients with a new colon cancer diagnosis who underwent unplanned (urgent or emergent) colon resection or diversion.

Prior symptomatic emergency department visits within 90 days before unplanned colon surgery.

The primary outcome was 30-day readmission or emergency department revisit. The secondary outcomes were length of stay, reoperation, and discharge disposition.

Of the 11,786 patients with colon cancer who underwent unplanned colon surgery, 1,158 (9.8%) had a prior symptomatic emergency department visit. The median time from prior symptomatic emergency department visit to unplanned surgery was 16 days with an interquartile range of 5-39 days. Age 18-50 was associated with 1.92 increased adjusted odds of prior symptomatic emergency department visits (95% confidence interval, 1.56-2.36) compared with patients 50-64 years old. Non-Hispanic Blacks had 1.43 increased adjusted odds of prior symptomatic emergency department visits (95% confidence interval, 1.19-1.73) compared with non-Hispanic Whites. Patients in rural home settings had 1.70 increased adjusted odds of prior symptomatic emergency department visits (95% confidence interval, 1.31-2.17) compared with patients in urban home settings. Hospitals with greater than 50% non-Hispanic Black discharges had 0.8 lower adjusted odds of having a prior symptomatic emergency department visit (95% confidence interval, 0.64-0.99) compared with hospitals with fewer than 25% non-Hispanic Black discharges. Prior symptomatic emergency department visits were associated with a 1.17 increase in adjusted odds of 30-day postoperative readmission or emergency department revisit following unplanned colon surgery (95% confidence interval, 1.01- 1.35).

There is an association between antecedent symptomatic emergency department utilization and later unplanned surgery.