Emergency Department Visits Within 90 Days of Elective Hand Surgery: A Healthcare Utilization Study.

Abstract

Introduction: Emergency department (ED) visits following elective surgeries place significant strain on already overburdened healthcare systems. In Nova Scotia, carpal tunnel release (CTR) and trigger finger release (TFR) are the most common elective hand surgeries performed. This study sought to determine the rates, reasons, and risk factors associated with ED visits following elective outpatient hand surgery. Methods: Patients who underwent CTR or TFR between April 1, 2016 and March 31, 2022, and visited any Nova Scotia ED within 90 days of surgery were identified using provincial healthcare databases. A chart review was completed to explore ED timing, reasons for presentation, and predetermined systems-level factors. Results: During the retrospective period, 2690 patients underwent CTR and 1103 patients underwent TFR. For CTR, 159 patients (5.97%) presented to the ED within 90 days of surgery for surgery-specific concerns. The most common presentation was surgical site infection (2.16%), wound check (1.60%), and suture removal (1.04%). For TFR, 63 (5.71%) patients presented to the ED within 90 days. Similarly, surgical site infection was the most common presentation (2.63%) followed by suture removal (1.45%) and wound check (1.18%). The most frequent timing for ED presentation was days 13-15 (27.9%). Conclusion: In an evaluation of true healthcare utilization after elective surgery, ED visits for surgery-specific concerns after CTR and TFR were nearly 6%, far exceeding expected complication rates. As the presentations are manageable in an outpatient clinic or office setting, a mixed-methods patient-oriented intervention is planned to redirect this population away from the ED.