Emergency Department Utilisation after Elective Hand Surgery and Distal Radius Fracture Fixation Is Associated with Mean Area Income.

Abstract

Background: Emergency department (ED) utilisation after surgery is a potentially preventable complication and a focus of health system improvement programmes. Understanding whether mean area income is a risk factor for increased ED utilisation can guide how resources are deployed to reduce unnecessary utilisation. In this study, we tested whether there is an association between mean area income and ED utilisation after hand surgery. Methods: Using a national administrative claims database, we performed a retrospective cohort study of patients who underwent common upper-extremity surgeries. We evaluated ED utilisation within 7 and 30 days after surgery and subdivided the number of ED visits by region and by procedure. We performed multivariable logistic regression to evaluate the association between mean area income and the odds of an ED visit. Results: We identified 2,123,692 patients; 1,851,113 (87%) underwent elective upper extremity surgeries, and 272,579 (13%) underwent distal radius fracture fixation. Overall, compared to patients from areas with income ≥ $65,000, those from areas with income < $65,000 had a higher incidence of any ED utilisation at both 7 and 30 days postoperatively. In multivariable analyses, each $10,000 increase in mean area income was associated with a decrease in odds of an ED visit by 5%-6% at both 7 and 30 days postoperatively. Conclusions: Mean area income has a progressive, inverse association with ED utilisation after both elective upper extremity and distal radius fracture surgery. Mean area income is a contextual factor that can be used to identify and support patients at risk of postoperative ED utilisation. Level of Evidence: Level III (Prognostic).