Study finds high rate of post-surgical ER visits among seniors

A new study revealed that post-surgical emergency visits may become a solid measure of hospital quality.

The study, published in the September issue of the journal Health Affairs, found nearly one in five older adults who have common operations on their hearts, hips, backs, colons and major blood vessels will end up in the emergency room within a month of their hospital stay.

University of Michigan Medical School researchers said they were most surprised to discover that some hospitals had four times the rate of post-surgery emergency care for their patients compared with other hospitals.

The research team analyzed Medicare data of 2.4 million adults who had at least one of six common operations in a three-year period. More than four percent had two or more ED visits within 30 days of leaving the hospital. And more than half of the patients who sought emergency care were readmitted to the hospital directly from the ED.

The study looked at six common operations:

  • Angioplasty or other minimally invasive heart procedures
  • Coronary artery bypass
  • Hip fracture repair
  • Back surgery
  • Elective abdominal aortic aneurysm repair
  • Colectomy or removal of part of the colon

Elderly patients who had these operations typically returned to the emergency room due to cardiovascular and respiratory conditions, infections, complications with the site of their surgery or procedure incision, and abdominal or gastrointestinal problems.

"This research is a high-altitude look at this problem, and suggests that we should really be doing more investigation into what is driving the frequency with which patients need to come into the emergency department," said Keith Kocher, M.D., the study's lead author and a U-M emergency physician. "We should be looking for things we can do as a health system to head off the need for an ED visit in the first place, or to deliver care in the ED that can prevent a hospital readmission if we can."

In addition to using post-surgery emergency visit rates as an opportunity for surgical and inpatient teams to do a better job at educating patients and managing their care in the first days after they go home, Kocher and his colleagues see a potential role for emergency physicians as well.

"An emergency visit by a surgical patient is a signifier of a problem in the transition from the hospital to the outpatient setting," he said. "Emergency visits by post-surgery patients could be used to re-establish coordination of care, as well as deliver treatment and create management plans to prevent readmission."

Integrating care across all settings might help hospitals reduce their post-surgery emergency care rate, Kocher said. And as readmission penalties mount, hospitals may begin to focus more on emergency physicians' decision-making process regarding readmitting a patient from the ED.

The study's results echo similar conclusions of a study published this spring in the Annals of Emergency Medicine that found nearly a quarter of discharged hospital inpatients end up in the emergency department within 30 days, but hospitals ignore the significance of those visits because fewer than half result in readmission.

Considering ED visits as a return to an acute-care setting could help hospitals "intervene in a cycle of frequent rehospitalizations," researchers from the University of Pennsylvania reported in the study.

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