Emergency Department Use After Outpatient Surgery Among Dually Enrolled VA and Medicare Patients.
Emergency Department Use After Outpatient Surgery Among Dually Enrolled VA and Medicare Patients.
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DOI：
10.1097/qmh.0000000000000225
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发表时间：
2019
影响因子：
1.2
通讯作者：
Pizer SD
中科院分区：
文献类型：
--
作者：
Mull HJ;Rosen AK;Charns MP;OʼBrien WJ;Hawn MT;Itani KMF;Pizer SD
门诊手术后使用急诊室（艾德）可能与手术相关的患者安全问题相关。我们对普外科、泌尿外科、骨科、耳鼻喉科和足科手术后7天内使用艾德的情况进行了描述，并按专业评估了与这些就诊相关的因素。我们计算了2011-2013年在退伍军人健康管理局（VA）和医疗保险中双重登记的>65岁的退伍军人的术后艾德就诊率，检查了诊断并使用逻辑回归来模拟与艾德护理相关的患者，程序和设施因素。在63，279例门诊手术中，2，778例（4.4%）在7天内进行了艾德访视;其中23%为非VA机构。比率从泌尿科和耳/鼻/喉>5%到骨科和足科<3%不等。泌尿生殖系统症状和手术并发症是各专业的常见诊断。没有患者、手术或设施因素与每个专科的艾德使用相关。一小部分退伍军人管理局门诊手术导致使用艾德。值得注意的是，1/4的术后艾德访视可能被VA遗漏，因为它们发生在非VA机构。因泌尿系统问题或手术并发症就诊艾德可能是可以预防的;然而，与使用艾德相关的因素因专业而异，表明可能需要不同的方法来改善结局。
Emergency department (ED) use following outpatient surgery may be associated with a surgery-related patient safety problem. We characterized ED use within 7 days of general, urology, orthopedic, ear/nose/throat and podiatry surgeries and assessed factors associated with these visits by specialty. We calculated the 2011-2013 postoperative ED visit rate for Veterans >65 dually-enrolled in the Veterans Health Administration (VA) and Medicare, examined diagnoses and used logistic regression to model patient, procedure and facility factors associated with ED care. Among 63,279 outpatient surgeries, 2,778 (4.4%) resulted in an ED visit within 7 days; 23% of these were to non-VA facilities. Rates varied from >5% for urology and ear/nose/throat, to <3% for orthopedic and podiatry specialties. Genitourinary symptoms and surgical complications were common diagnoses across specialties. No patient, procedure or facility factors were associated with ED use for every specialty. A small proportion of VA outpatient surgeries result in ED use. Notably, 1/4 of postoperative ED visits may be missed by the VA because they occur in non-VA facilities. ED visits for urinary issues or surgical complications may be preventable; however, factors associated with ED use vary by specialty suggesting different approaches may be needed to improve outcomes.