title: Emergency Department Visits After Hand Surgery Are Common and Usually Related to Pain or Wound Issues.
abstract: BACKGROUND
  As payment models shift toward a focus on value and reimbursement becomes increasingly tied to quality and patient experience, minimizing unexpected acute health needs has become a priority for both policymakers and clinical leaders. Despite recent emphasis on emergency department (ED) visits as a quality measure in surgery, little is known about the role of the ED in the early postoperative period after hand surgery.
  
  
  OBJECTIVE
  The purpose of this study was to determine the rates, reasons, and factors associated with ED visits within 30 days of elective outpatient hand surgery.
  
  
  METHODS
  Using our institutional database for 2009 through 2013, we assessed ED visit rates for 2332 patients undergoing carpal tunnel or trigger finger release. Medical records were manually reviewed to ascertain the primary reason for the ED visit. Multivariable logistic regression modeling was used to identify factors independently associated with ED use.
  
  
  RESULTS
  A total of 67 patients (3%) experienced at least one ED visit within 30 days of hand surgery (carpal tunnel: 3%; trigger finger: 3%). Most visits (66%) occurred within the first 2 weeks of surgery, and 31% led to hospitalization. The most common reasons for ED visits were pain (18%) and wound issues (16%). Unmarried and medically infirm patients were more likely to visit the ED.
  
  
  CONCLUSIONS
  ED visits after hand surgery are common, often related to the procedure, and potentially responsive to quality improvement initiatives. Targeted efforts to educate patients about pain management, wound care, and the expected course of recovery before surgery, together with close postoperative contact (eg, routine phone calls, facsimile correspondence by email, or secure messaging) may limit visits to the ED.
  
  
  METHODS
  Level IV, prognostic study.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA. marianofurrer@gmail.com.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Menendez
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000592:standards; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D010359:Patient Readmission; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D058971:Tenotomy / Q000009:adverse effects* / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome; D052582:Trigger Finger Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014945:Wound Healing