Purpose
(1) To identify the most common reasons for presentation to the emergency department
(ED) after hip arthroscopy and (2) to determine preoperative risk factors for these
ED visits.
Methods
Patients undergoing elective hip arthroscopy between the start of 2014 and the third
quarter of 2015 were retrospectively evaluated using discharge records from New York
and Florida. The primary outcome was all-cause 7-, 30-, and 90-day ED utilization.
Reasons for presentation to the ED were recorded and manually stratified. Bivariate
and multivariate analyses were performed to identify independent predictors of ED
utilization.
Results
The overall rate of postoperative ED visits after hip arthroscopy was 1.8% at 7 days,
3.5% at 30 days, and 6.6% at 90 days. Postoperative pain was the most common reason
for visiting the ED at all time points (25.4%, 23.7%, and 20.3%, respectively), followed
by gastrointestinal complaints (19.5%, 15.0%, and 15.3%, respectively) and neurologic
complaints (8.7%, 9.8%, and 10.5%, respectively). Female sex (relative risk [RR],
1.86; 95% confidence interval [CI], 1.35-2.54; P < .001), Medicare insurance (RR, 2.39; 95% CI, 1.41-4.04; P < .001), and Medicaid insurance (RR, 3.45; 95% CI, 2.37-5.04; P < .001) were identified as independent risk factors for ED utilization at 90 days
postoperatively. Of all patients who presented to the ED, only 3.9% were admitted
to the hospital.
Conclusions
ED visits after elective hip arthroscopy are uncommon. The most common reason for
a visit is postoperative pain, followed by gastrointestinal and neurologic complaints.
After accounting for confounding, we found that female sex, Medicare and Medicaid
insurance status, and hypertension were risk factors for all-cause ED visits at up
to 90 days postoperatively. Only 4% of patients who present to the ED require inpatient
hospital admission.
Level of Evidence
Level IV, retrospective cohort study.
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Article info
Publication history
Published online: February 25, 2020
Accepted:
February 1,
2020
Received:
July 15,
2019
Footnotes
See commentary on page 1584
The authors report the following potential conflicts of interest or sources of funding: M.S. receives personal fees from Stryker, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Emergency Department Evaluation After Hip Arthroscopy Occurs More than Expected: Here’s Where Patient Education and a Multimodal Approach to Pain Management Can Be HelpfulArthroscopyVol. 36Issue 6
- PreviewHip arthroscopy is known to be a relatively safe procedure with a limited and unique set complications and low hospital readmission rates. Many patients, however, may seek emergency department evaluation after surgery for postoperative pain or complaints unrelated to the most commonly cited complications, such as traction neuropraxia. It is important to recognize and understand the reasons why patients seek medical care after surgery because many of these encounters may be preventable with optimization of perioperative multimodal pain control regimens and proper patient education regarding their expected postoperative course.
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