title: Post-appendectomy visits to the emergency department within the global period: a target for cost containment.
abstract: BACKGROUND
  Postoperative visits to the emergency department (ED) instead of the surgeon's office consume enormous cost.
  
  
  OBJECTIVE
  Postoperative ED visits can be avoided.
  
  
  METHODS
  Fully accredited, single-institution, 617-bed hospital affiliated with the University of Connecticut School of Medicine.
  
  
  METHODS
  Retrospective analysis of 597 consecutive patients with appendectomies over a 4-year period.
  
  
  METHODS
  Demographic and medical data, at initial presentation, surgery, and ED visit were recorded as categorical variables and statistically analyzed (Pearson chi(2) test, Fisher exact test, and linear-by-linear). Costs were calculated from the hospital's billing department.
  
  
  RESULTS
  Forty-six patients returned to the ED within the global period with pain (n = 22, 48%), wound-related issues (n = 6, 13%), weakness (n = 4, 9%), fever (13%), and nausea and vomiting (n = 3, 6%). Thirteen patients (28%) required readmission. Predictive factors for ED visit postoperatively were perforated appendicitis (2-fold increase over uncomplicated appendicitis) and comorbidities (cardiovascular or diabetes). The cost of investigations during ED visits was $55,000 plus physician services.
  
  
  CONCLUSIONS
  ED visits during the postoperative global period are avoidable by identifying patients who may need additional care; improving patient education, optimizing pain control, and improving patient office access.
authors.affiliation: Department of Surgery, University of Connecticut School of Medicine, Farmington, USA.
authors.forename: Francesco A
authors.initials: FA
authors.lastname: Aiello
authors.forename: Erica R
authors.initials: ER
authors.lastname: Gross
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Krajewski
authors.forename: Robert
authors.initials: R
authors.lastname: Fuller
authors.forename: Anthony
authors.initials: A
authors.lastname: Morgan
authors.forename: Andrew
authors.initials: A
authors.lastname: Duffy
authors.forename: Walter
authors.initials: W
authors.lastname: Longo
authors.forename: Robert
authors.initials: R
authors.lastname: Kozol
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chandawarkar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D016009:Chi-Square Distribution; D002648:Child; D015897:Comorbidity; D003363:Cost Control / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics* / Q000628:therapy*; D012189:Retrospective Studies