Post-appendectomy visits to the emergency department within the global period: a target for cost containment.
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.
Aiello
Francesco A
FA
Department of Surgery, University of Connecticut School of Medicine, Farmington, USA.
Gross
Erica R
ER
Krajewski
Aleksandra
A
Fuller
Robert
R
Morgan
Anthony
A
Duffy
Andrew
A
Longo
Walter
W
Kozol
Robert
R
Chandawarkar
Rajiv
R
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