Incidence and risk factors of unplanned emergency department visits following thoracic surgeryCentral MessagePerspective
Merel H.J. Hazewinkel, BSc,
Remco R. Berendsen, MD,
Rik C.J. van Klink, MD, PhD, MA,
Hans Dik, MD,
Jeroen Wink, MD, PhD,
Jerry Braun, MD, PhD,
Robert A.F. de Lind van Wijngaarden, MD, PhD
Affiliations
Merel H.J. Hazewinkel, BSc
Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
Remco R. Berendsen, MD
Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
Rik C.J. van Klink, MD, PhD, MA
Department of Pulmonology, Alrijne Hospital, Leiderdorp, The Netherlands
Hans Dik, MD
Department of Pulmonology, Alrijne Hospital, Leiderdorp, The Netherlands
Jeroen Wink, MD, PhD
Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
Jerry Braun, MD, PhD
Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
Robert A.F. de Lind van Wijngaarden, MD, PhD
Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardio-Thoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Address for reprints: Robert A. F. de Lind van Wijngaarden, MD, PhD, Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Background: Unplanned visits for care following a surgical procedure can represent a lapse in quality of care. The purpose of this study was to define the proportion of patients undergoing thoracic surgery who return to the emergency department (ED) within 6 months after discharge and the reasons for the returns. In addition, the risk factors for ED visits after thoracic surgery were identified. Methods: All adult patients undergoing thoracic surgery at the Leiden University Medical Center between January 1, 2016, and December 31, 2017, were reviewed. To identify potential risk factors for ED return visits, a multivariate regression analysis was performed. A subgroup analysis of patients who reported pain during the ED visit was performed to identify the risk factors for pain-related return to the ED. Results: Of 277 patients who underwent thoracic surgery, 27.4% (n = 76) returned to the ED within 6 months after discharge. Among these patients, 41 (53.9%) presented with postoperative pain. Younger patients (odds ratio [OR], 0.98; P = .04), those who were operated on through a thoracotomy (OR, 2.92; P = .04), and those reporting a high pain score on the ward (OR, 1.98; P < .001) were at increased risk of returning to the ED. Conclusions: The rate of patients returning to the ED after thoracic surgery was high. Pain was the most frequently reported reason for unplanned ED visits. The results of this study highlight the need to optimize the postoperative care and the follow-up of patients undergoing thoracic surgery.
