Risk Factors of Emergency Department Utilization After Outpatient Surgery for Sports-Related Injuries

Mingda Chen; Yazdan Raji; Lakshmanan Sivasundaram; James E Voos

doi:10.5435/JAAOS-D-22-00715

Risk Factors of Emergency Department Utilization After Outpatient Surgery for Sports-Related Injuries

J Am Acad Orthop Surg. 2023 Dec 22. doi: 10.5435/JAAOS-D-22-00715. Online ahead of print.

Authors

Mingda Chen¹, Yazdan Raji, Lakshmanan Sivasundaram, James E Voos

Affiliation

¹ From the Case Western Reserve University School of Medicine, Cleveland, OH (Chen, and Voos), the Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH (Raji and Voos), and the Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL (Sivasundaram).

PMID: 38147678
DOI: 10.5435/JAAOS-D-22-00715

Abstract

Introduction: The purpose of this study was to identify the most common reasons for and risk factors associated with postoperative emergency department (ED) utilization after orthopaedic procedures for sports-related injuries.

Methods: Using the 2014 to 2016 New York and Florida State Databases from the Healthcare Cost and Utilization Project, outpatient procedures for sports-related injuries were identified. Patient records were tracked across care settings within each state to determine the rate and reasons of postoperative ED utilization within 90 days after the index surgery. Multiple logistic regression models were used to identify risk factors associated with ED visits at 0 to 7 days, 8 to 30 days, 31 to 90 days postoperatively.

Results: A total of 28,192 surgery visits for sports-related injuries were identified, with knee arthroscopy with partial meniscectomy (18.48%) and arthroscopic anterior cruciate ligament reconstruction (17.04%) as the two most common procedures treating sports injuries. The overall postoperative ED utilization rates were 1.6% (0 to 7 days postoperative), 1.3% (8 to 30 days) and 2.1% (31 to 90 days). The main cause of ED visits was markedly different during each postoperative period: mainly musculoskeletal pain (36.3%) during 0 to 7 days, either musculoskeletal pain (17%) or injury (16.6%) during 8 to 30 days, and injury (24.2%) during 31 to 90 days. Sports with the highest ED utilization in descending order were basketball, football, ice/snow sports, walking/running, cycling, and soccer. Relative to open procedures, arthroscopic procedures were 0.71 times as likely to result in a postoperative ED visit. Independent predictors of ED utilization up to 90 days postoperatively included renal failure, chronic pulmonary disease, psychosis, diabetes, and alcohol abuse.

Discussion: Rate of ED utilization after outpatient surgery for sports-related injuries is low (<2.2%), with postoperative musculoskeletal pain and reinjury as the two most common causes, highlighting the importance of postoperative pain management and injury prevention. Arthroscopic procedures showed markedly lower ED utilization compared with open surgery, although not indicative of overall superiority.

Level of evidence: III, Retrospective Cohort Study.