Preoperative Emergency Department Usage is a Sentinel Marker of Worsened Posterior Lumbar Interbody Fusion Outcome

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2025-02-19 DOI:10.1016/j.wneu.2025.123696

Adeline L. Fecker , Maryam N. Shahin , Spencer Smith , Jung U. Yoo , Christina H. Wright , Josiah N. Orina , Won Hyung A. Ryu , Clifford Lin , Jonathan A. Kark , Travis C. Philipp , James M. Wright III

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引用次数: 0

Abstract

Background

Utilization of the emergency department (ED) is associated with medical and social comorbidities. These factors may also be associated with medical complications after complex surgeries. This study investigated how preoperative ED use increases risk of posterior lumbar interbody fusion (PLIF) complications.

Methods

We identified adult PLIF patients treated between 2016 and 2019 in the PearlDiver Claims Database. Clinical variables including preoperative ED use within 180 days were collected using International Classification of Disease (ICD-10) codes. Risk difference was calculated, and multivariable regression was performed.

Results

This study included 13,010 (21.1%) patients who went to the ED before surgery and 48,065 (78.9%) who did not. Having a preoperative ED visit significantly increased risk of a postoperative ED visit by 28.7 percentage points, 90-day readmission by 3.8 percentage points, and 30-day major-medical complications by 3.4 percentage points. Risk of these outcomes increased in a dose-dependent fashion. Compared with patients with zero preoperative ED visits, patients who had 6 or more preoperative ED visits had an 82.0 percentage point increase in risk for a postoperative ED visit, a 46.5 percentage point increase for six or more ED visits, a 6.1 percentage point increase for major medical complications, and 10.6% increase for readmission.

Conclusions

Patients with any preoperative ED visit had an increased risk for postoperative ED use, readmission, and medical complications. The risk difference increased with each additional preoperative visit. Patient counseling and protocols that reduce preventable ED visit in the preoperative period may reduce a patient's risk for costly postoperative complications.

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS