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Emergency department visits within 90 days of elective hand surgery: A healthcare utilization study
Katie Ross, MD, BKinH
1; Haley Glazebrook, MHA
1; Justin MacLellan, MSc
1; JoAnne Douglas, MSc
1; Evan Nemeth, MSc
1; Julia Harrison, PhD
2; Emily Krauss, MD, MSc
11Dalhousie University, Halifax, NS, Canada; 2Dalhousie University, Division of Plastic Surgery, Halifax, NS, Canada
INTRODUCTION: Canadian Emergency departments (ED) are currently in crisis, with numerous system factors contributing to the burden. Reducing post-operative visits after common elective surgeries is one key target to decrease ED burden. In Nova Scotia, carpal tunnel release (CTR) and trigger finger release (TFR) are the most common elective hand surgeries performed. Surprisingly, these minor procedures also have some of the highest absolute numbers of returns to the ED. The purpose of this study is to determine the rates, reasons, and risk factors associated with ED visits following elective outpatient hand surgery.
METHODS: Patients who underwent CTR or TFR surgery between April 1, 2016 - March 31, 2022 and visited any Nova Scotia ED within 90 days of surgery were identified using provincial healthcare databases. A chart review was completed to explore ED timing, reasons for presentation, and predetermined systems-level factors (geographic distribution, primary care access). All procedures were performed under wide awake, local anesthesia, no tourniquet (WALANT) and all patients received perioperative verbal and written education.
RESULTS: During the retrospective period, 2690 patients underwent CTR and 1,103 patients underwent TFR. For CTR, 159 patients (5.91%) presented to the ED within 90 days of surgery for surgery specific concerns. The most common presentation was surgical site infection (2.16%) followed by wound check (1.60%) and suture removal (1.04%). For TFR, 63 patients presented to the ED within 90 days, resulting in a post-operative ED rebound rate of 5.71% for surgical concerns. Similarly, surgical site infection was the most common reason (2.63%) followed by suture removal (1.45%) and wound check (1.18%). The most frequent post-operative period for ED presentation were days 13-15. No patients required hospital admission, and the majority of these patients were listed as having a primary care provider (93.8%).
CONCLUSIONS: In Nova Scotia, ED visits for surgery-specific concerns after elective CTR and TFR were nearly 6%. Despite all procedures in this cohort being done under WALANT with real time verbal and written education provided, there was an inappropriate overuse of the ED with higher than published complication rates. This overuse aligns with timing for wound concerns. With the majority of these presentations able to be managed by surgeons and primary care providers, a mixed-methods patient oriented intervention is now planned to help redirect this population away from the ED.
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