Unplanned Emergency Department Visits Within 90 Days of Breast Reduction Surgery: A Retrospective Cohort Study.

Abstract

Introduction: Emergency departments (EDs) have been under substantial strain in recent years, far exceeding current capacities and attracting media attention and calls for improved staffing and resources. A portion of patients presenting to EDs include postoperative patients. We sought to identify the proportion of patient presenting postoperatively to the ED after common plastic surgery elective procedures to identify target populations and presentations for diversion from the ED. This study investigates the incidence and etiology of postoperative ED presentations in the bilateral reduction mammoplasty (BBR) population, the most common general anesthetic plastic surgery procedure in our jurisdiction. Methods: This retrospective healthcare-utilization study collected all ED visits across a single province from April 2016 to March 2022 within 90 days postoperatively from BBR. Visit timing, frequency, chief complaint, diagnosis, and discharge destination from ED were recorded and analyzed for relationships to the index surgery and for predictable patterns. Results: Of the 452 patients who underwent bilateral breast reduction mammoplasty between 2016 and 2022, 75 (16.6%) patients presented to the ED within 90-day postoperatively. Of these 75 patients, 49 were directly related to the primary surgery (10.8% surgical ED return rate) for complaints of surgical site infection (36.7%), pain (30.6%), wound check (22.4%), swelling (20.4%), and bleeding (20.4%). Conclusion: After routine reduction mammoplasty, 10.8% of patients presented to the ED for surgery-specific concerns. This study describes targets to assist in diverting routine postoperative visits from the ED back toward the surgeon's office. Enhanced patient education, improved follow-up infrastructure, and pain control education are possible areas for intervention.