Risk Factors for Postoperative Emergency Department Visits After Endoscopic Skull Base Surgery

Introduction: Unplanned emergency department (ED) visits reflect additional costs and stress to patients and hospitals. While the reasons and clinical course for return to the ED have been described, few investigations identify risk factors for return to the ED, such as socioeconomic factors including the Area Deprivation Index (ADI). The objective of this study was to identify potential risk factors for ED visits within 30 days after endoscopic skull base surgery (ESBS).

Methods: This was a retrospective cohort study of adult patients who underwent ESBS by skull base teams at our institution between January 2017 – December 2019. Data were collected through medical record review. Univariable analyses were performed with the Fisher exact test, chi-squared test, Student t-test, and Wilcoxon rank-sum test. Multivariable analysis was performed with a logistic regression model. Significance was set at p=0.05.

Results: Among 288 patients, 54 (18.7%) patients visited the ED within 30 days of discharge after surgery. Patients who visited the ED were significantly more likely to be current tobacco users (16.7% versus 6.8%, p=0.03) and have preoperative immunosuppression, with either medications or immunological conditions, compared to patients who did not visit the ED (11.1% versus 2.1%, p=0.01). There were no other significant differences in clinical characteristics or socioeconomic factors as the ADI. On multivariable logistic regression, immunosuppression (odds ratio=6.43, 95% CI: 1.84-22.43, p=0.003) and current tobacco use (odds ratio=2.70, 95% CI: 1.10-6.63, p=0.03) were significant predictors of ED visits when adjusted for diabetes mellitus and inflammatory/non-tumorous tissue pathology. Among patients who visited the ED, 15 (27.8%) were readmitted.

Conclusion : Improved prediction of ED visits can inform postoperative care and optimize resource utilization. In this cohort, immunosuppression and current tobacco use predicted increased odds of ED visits. Socioeconomic factors were not predictive of ED visits. Future research is needed to determine the potential mechanisms underlying these associations.