(I-635) Modifiable Risk Factors of Emergency Department Visits Following Elective Cervical and Lumbar Surgeries: A Prospective, Multi-Institution Analysis
Neurosurgery Resident University of Michigan Ann Arbor, Michigan, United States
Introduction: Emergency department (ED) visits after elective spinal surgery are relatively common with rates ranging from 9.4-29% within 90 days postoperatively. ED visits are very costly and so reduction of ED visits is of significant importance. The purpose of this study was to evaluate the reasons for ED visits as well as determine potentially modifiable risk factors.
Methods: Data was queried from the multi-center Michigan Spine Surgery Improvement Collaborative (MSSIC) registry, which includes patients undergoing cervical and lumbar degenerative spinal surgery. A total of 16,224 patients treated from July 2020 to November 2021 were included. ED visits occurring within 90 days of surgery were analyzed utilizing univariate and multivariate regression analysis.
Results: Of the 16,224 patients, 2,024 (12.5%) presented to the ED during the study period. The reasons for the ED visits were numerous; however, the most common reason was pain (31.5%) followed by abdominal problems (15.8%). Univariate analysis found a large number of significant demographic, surgical and inpatient characteristic differences between those who returned to the ED vs those that did not. On multivariate analysis, age (OR 0.93, 95% CI 0.91-0.95), private insurance (OR 0.78, 95% CI, 0.69-0.88) and preop ambulation status (OR 0.89, 95%CI, 0.79-0.99) were associated with decreased ED visits. Conversely, Black race (OR 1.30, 95% CI, 1.10-1.53), DVT (OR 1.34, 95% CI 1.21-1.49), anxiety (OR1.31, 95% CI, 1.17-1.47), osteoporosis (OR 1.21, 95%CI 1.07-1.36), COPD (OR 1.18, 95% CI 1.05-1.34), ASA>2 (OR 1.21, 95% CI 1.09.1.35), LOS>3days (OR 1.28, 95% CI 1.14-1.43) were associated with increased ED visits.
Conclusion : The most common reasons for ED visits were pain and abdominal complaints including constipation. Increased focus on postoperative pain management and bowel regimens can potentially reduce ED visits. Of the risk factors observed, osteoporosis and anxiety are possibly modifiable and warrant attention.
