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Preoperative Emergency Department Use Predicts Posterior Lumbar Interbody Fusion Outcomes

Friday, May 3, 2024

    Presenting Author(s)

  • Adeline Fecker, BS (she/her/hers)

    Medical Student
    Oregon Health & Science University
    Portland, OR, US

    • Co-Author(s)

  • Maryam N. Shahin, MD

    Resident
    Department of Neurological Surgery, Oregon Health and Science University
    Portland, Oregon, United States

  • JW

    James Wright, MD

    Assistant Professor of Neurosurgery
    Department of Neurological Surgery, Oregon Health and Science University
    Portland, Oregon, United States

  • JY

    Jung Yoo, MD

    Professor of Orthopedics
    Department of Orthopaedic Surgery, Oregon Health & Science University, United States

Introduction: There is little known about the effect of preoperative emergency department (ED) use on post-operative outcomes. This study investigated the outcomes of posterior lumbar interbody fusion (PLIF) patients with varying degrees of preoperative ED usage.

Methods: We identified PLIF patients between 2016-2019 using the PearlDiver database. Variables including age, gender, obesity, tobacco use, opioid use, co-morbidities, pre-operative emergency department use within 180 days prior to surgery, post-operative emergency department visits in first 180 days after surgery, re-admissions within 90 days, and medical complications within 30 days were extracted.

Results: 12,937 (21.2%) patients went to the ED before surgery and 48,065 (78.8%) did not. Preoperative ED users were younger (59.5 vs 62.9; p< 0.0001) and had higher Charlson Comorbidity Index (CCI) (2.8 vs 2.3; p< 0.0001). Any preoperative ED visit was the strongest predictor for postoperative ED visit (OR=2.80; 95% CI 2.68-2.92), readmission (OR=1.40; 95% CI 1.29-1.52), and medical complications (OR=1.53; 95% CI 1.38-1.70). Risk of complication increased in a dose dependent fashion. Patients with one preoperative ED visit were 2.5 times more likely to visit the ED at least once after surgery, 1.5 times more likely to be readmitted, and 1.6 times more likely to have a medical complication compared to patients who had no preoperative ED visits. Patients who had six preoperative ED visits were 68.4 times more likely to visit the ED six more times after surgery, 3.6 times more likely to be readmitted, and 3.3 times more likely to have a medical complication.

Conclusion : Patients who visit the ED, even once, before surgery have a high likelihood of postoperative ED use, readmission, and medical complications. The risk increases with each additional preoperative ED visit. We encourage providers to evaluate a patient’s ED use before surgery and establish protocols to address preoperative issues outpatient.