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Emergency Department Use After Outpatient Surgery Among Dually Enrolled VA and Medicare Patients

Mull, Hillary J. PhD, MPP; Rosen, Amy K. PhD; Charns, Martin P. DBA; O'Brien, William J. MS; Hawn, Mary T. MD, MPH; Itani, Kamal M. F. MD; Pizer, Steven D. PhD

doi: 10.1097/QMH.0000000000000225
Original Research

Background: Emergency department (ED) use following outpatient surgery may be associated with a surgery-related patient safety problem. We characterized ED use within 7 days of general, urology, orthopedic, ear/nose/throat, and podiatry surgical procedures and assessed factors associated with these visits by specialty.

Methods: We calculated the 2011-2013 postoperative ED visit rate for Veterans older than 65 years dually enrolled in the Veterans Health Administration (VA) and Medicare, examined diagnoses, and used logistic regression to model patient, procedure, and facility factors associated with ED care.

Results: Among 63 279 outpatient surgical procedures, 2778 (4.4%) resulted in an ED visit within 7 days; 23% of these were to non-VA facilities. Rates varied from more than 5% for urology and ear/nose/throat, to less than 3% for orthopedic and podiatry specialties. Genitourinary symptoms and surgical complications were common diagnoses across specialties. No patient, procedure, or facility factors were associated with ED use for every specialty.

Conclusions: A small proportion of VA outpatient surgical procedures result in ED use. Notably, nearly one-fourth of the postoperative ED visits may be missed by the VA because they occur in non-VA facilities. ED visits for urinary issues or surgical complications may be preventable; however, factors associated with ED use vary by specialty, suggesting different approaches may be needed to improve outcomes.

Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts (Drs Mull, Rosen, and Charns and Mr O'Brien); Department of Surgery, Boston University School of Medicine, Massachusetts (Drs Mull, Rosen, and Itani); Department of Health Law, Policy and Management, Boston University School of Public Health, Massachusetts (Drs Charns and Pizer); Palo Alto VA Medical Center, and Stanford University School of Medicine, California (Dr Hawn); Department of Surgery, VA Boston Healthcare System, and Harvard Medical School, Boston, Massachusetts (Dr Itani); and Partnered Evidence-Based Policy Resource Center, Department of Veterans Affairs, Boston, Massachusetts (Dr Pizer).

Correspondence: Hillary J. Mull, PhD, MPP, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152M), Boston, MA 02130 (

This research was supported by the VA Health Services Research and Development Service (HSR&D) Career Development Award (grant number CDA 13-270, P.I. Mull).

Statements contained in this article reflect the views of the authors and do not represent the official positions of the US Department of Veterans Affairs or other author-affiliated organizations.

The authors wish to acknowledge the contribution of Dr Nathalie McIntosh in performing an initial literature review to support this article. She did not receive compensation for this work.

The authors declare no conflicts of interest.

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