Post-appendectomy visits to the emergency department within the global period: A target for cost containment

Francesco A. Aiello, Erica R. Gross, Aleksandra Krajewski, Robert Fuller, Anthony Morgan, Andrew Duffy, Walter Longo, Robert Kozol, Rajiv Chandawarkar

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background: Postoperative visits to the emergency department (ED) instead of the surgeon's office consume enormous cost. Hypothesis: Postoperative ED visits can be avoided. Setting: Fully accredited, single-institution, 617-bed hospital affiliated with the University of Connecticut School of Medicine. Patients: Retrospective analysis of 597 consecutive patients with appendectomies over a 4-year period. Methods: Demographic and medical data, at initial presentation, surgery, and ED visit were recorded as categorical variables and statistically analyzed (Pearson χ2 test, Fisher exact test, and linear-by-linear). Costs were calculated from the hospital's billing department. Results: Forty-six patients returned to the ED within the global period with pain (n = 22, 48%), wound-related issues (n = 6, 13%), weakness (n = 4, 9%), fever (13%), and nausea and vomiting (n = 3, 6%). Thirteen patients (28%) required readmission. Predictive factors for ED visit postoperatively were perforated appendicitis (2-fold increase over uncomplicated appendicitis) and comorbidities (cardiovascular or diabetes). The cost of investigations during ED visits was $55,000 plus physician services. Conclusions: ED visits during the postoperative global period are avoidable by identifying patients who may need additional care; improving patient education, optimizing pain control, and improving patient office access.

Original languageEnglish (US)
Pages (from-to)357-362
Number of pages6
JournalAmerican journal of surgery
Volume200
Issue number3
DOIs
StatePublished - Sep 1 2010

Keywords

  • Appendectomy
  • Cost-containment
  • Emergency department visits
  • Global period
  • Postoperative care

ASJC Scopus subject areas

  • Surgery

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