Risk Factors for Emergency Department Visits After Hysterectomy for Benign Disease
| Autor: | Sawsan As-Sanie, Neil Kamdar, Afton Hassett, N. Mahnert, Daniel M. Morgan, Bethany Skinner, Keith E. Kocher, Courtney S. Lim |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
medicine.medical_specialty Gastrointestinal Diseases medicine.medical_treatment Hysterectomy Pelvic Pain Logistic regression Patient Readmission 03 medical and health sciences Postoperative Complications 0302 clinical medicine Patient Education as Topic Risk Factors Humans Medicine 030212 general & internal medicine Pain Measurement Uterine Diseases 030219 obstetrics & reproductive medicine business.industry Genitourinary system Pelvic pain Age Factors Obstetrics and Gynecology Secondary data General Medicine Emergency department Perioperative Middle Aged Female Urogenital Diseases humanities Emergency medicine Female medicine.symptom Emergency Service Hospital business Medicaid |
| Zdroj: | Obstetrics & Gynecology. 130:296-304 |
| ISSN: | 0029-7844 |
| DOI: | 10.1097/aog.0000000000002146 |
| Popis: | Objective To identify the incidence, indications, and risk factors for emergency department visits that do not result in readmission within 30 days of hysterectomy for benign disease. Methods We conducted a secondary data analysis of hysterectomies for benign disease using the Michigan Surgical Quality Collaborative, a statewide group of hospitals that voluntarily reports perioperative outcomes. Hysterectomies for benign disease were abstracted from January 1, 2013, to July 2, 2014. We examined the incidence of emergency department visits within 30 days after hysterectomy for benign disease and constructed a multivariable logistic regression model to identify risk factors for these visits. We focused on emergency department visits that did not result in readmission because they are more likely to represent avoidable encounters. Results Among the 10,274 women who underwent hysterectomy for benign disease during the study period, 932 (9.1%) presented to the emergency department and were not readmitted to the hospital. Based on a multivariable regression model, risk factors for emergency department visits after hysterectomy for benign disease were younger age, higher parity, Medicaid or self-pay insurance, prior venous thromboembolism, chronic obstructive pulmonary disease, preoperative surgical indication of chronic pelvic pain, and postoperative day 1 pain scores greater than 4 on a 0-10 numeric rating scale. The most common primary emergency department International Classification of Diseases, 9th Revision diagnoses were for pain (29.5% [n=275]), gastrointestinal (12.8% [n=118]), and genitourinary (10.7% [n=99]) complaints. Conclusion Approximately 1 in 11 women present to the emergency department, but do not result in readmission within 30 days of hysterectomy for benign disease. Emergency department visits might be avoided with expanded perioperative education and improved communication pathways for high-risk patients. |
| Databáze: | OpenAIRE |
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