Background

Care delivered in hospital-based emergency departments (ED) is a target for cost savings. ED utilization following hepatopancreatic surgery remains poorly defined. We sought to define the rate of ED utilization following liver and pancreatic resection, as well as to identify factors associated with ED visits post-discharge.

Methods

The Medicare 100% Standard Analytic Files were used to identify Medicare beneficiaries who underwent hepatectomy or pancreatectomy between 2013 and 2017. Claims associated with ED services were identified using the relevant Revenue Center Codes. Patient characteristics and postoperative outcomes associated with ED care within 30 days of discharge were investigated.

Results

Among 37,707 patients who underwent hepatopancreatic surgery, 10,323 (27.4%) had at least one ED visit within 30 days of discharge. Patients presenting to the ED were more likely to be male (OR 1.13, 95%CI 1.07–1.18). Patients undergoing a pancreatectomy (OR 1.39, 95%CI 1.32–1.47), as well as patients who had a perioperative complication (OR 1.16, 95%CI 1.10–1.23) and patients not discharged home (OR 1.41, 95%CI 1.33–1.49), were more likely to require ED care. In contrast, patients undergoing resection for cancer or surgery for an elective basis were less likely to present to the ED postoperatively (OR 0.92, 95%CI 0.87–0.97 and OR 0.22, 95%CI 0.20–0.23, respectively). Patients often had multiple ED visits within 30 days of discharge as 37.2% of patients presented to the ED with at least 2 visits. Visits were also most common in the immediate postoperative period, with 30.9% of ED visits taking place in the first 2 days from discharge. Among patients requiring postoperative ED care, 53.9% were readmitted within 30 days.

Conclusion

More than 1 in 4 patients undergoing hepatopancreatic surgery presented to the ED within 30 days of discharge, with most patients returning to the ED within the first week of discharge. A subset of patients had multiple ED visits. Future efforts should target patients most likely to be high ED utilizers to avoid the need for early post-discharge ED use.

中文翻译：

---

医疗保险受益人肝胰腺手术后急诊科的使用率

 背景

医院急诊科 (ED) 提供的护理是节省成本的目标。肝胰腺手术后急诊室的利用仍不明确。我们试图确定肝脏和胰腺切除术后急诊室的利用率，并确定与出院后急诊室就诊相关的因素。

 方法

Medicare 100% 标准分析文件用于识别 2013 年至 2017 年间接受过肝切除术或胰腺切除术的 Medicare 受益人。与 ED 服务相关的索赔是使用相关的收入中心代码来识别的。对出院 30 天内与 ED 护理相关的患者特征和术后结果进行了调查。

 结果

在 37,707 名接受肝胰腺手术的患者中，10,323 名患者 (27.4%) 在出院后 30 天内至少到过一次急诊科就诊。到急诊室就诊的患者更有可能是男性（OR 1.13，95%CI 1.07-1.18）。接受胰腺切除术的患者（OR 1.39，95% CI 1.32–1.47），以及出现围手术期并发症的患者（OR 1.16，95% CI 1.10–1.23）和未出院回家的患者（OR 1.41，95% CI 1.33– 1.49），更有可能需要急诊室护理。相比之下，接受癌症切除或择期手术的患者术后到急诊科就诊的可能性较小（分别为 OR 0.92，95%CI 0.87–0.97 和 OR 0.22，95%CI 0.20–0.23）。患者通常在出院后 30 天内多次就诊，37.2% 的患者至少就诊 2 次。术后即刻就诊也最常见，30.9% 的急诊就诊发生在出院后的前 2 天。在需要术后急诊护理的患者中，53.9% 在 30 天内再次入院。

 结论

超过四分之一的接受肝胰腺手术的患者在出院后 30 天内到急诊室就诊，大多数患者在出院第一周内返回急诊室。一部分患者曾多次就诊于急诊室。未来的努力应该针对最有可能是高 ED 使用率的患者，以避免出院后早期使用 ED 的需要。