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Emergency Department Visits After Hand Surgery: Where You Live Matters
Thompson Zhuang, MD MBA
1; Bill Young, BS
2; Robin N Kamal, MD
21University of Pennsylvania, Philadelphia, PA; 2Stanford University, Redwood City, CA
Introduction: Emergency department (ED) visits are a large, potentially preventable source of healthcare utilization and cost after outpatient hand surgery. Geographic social risk factors (e.g., socioeconomic deprivation) may place certain patients at a higher risk of postoperative ED utilization. In this study, we tested the null hypothesis that mean area income was not associated with ED utilization after hand surgery.
Methods: Using a large, national administrative claims database, we identified adults undergoing elective hand surgery (carpal tunnel/trigger finger/cubital tunnel/DeQuervain releases, ganglion cyst removals, limited palmar fasciectomies, carpometacarpal arthroplasties) or surgical fixation of distal radius fractures. The primary outcome was the incidence of any ED utilization within 7 or 30 days after surgery. Secondary outcomes included the number of ED visits within this period. The primary explanatory variable was mean area family income. We created multivariable logistic regression models to assess the association between mean area income and post-hand surgery ED utilization, adjusting for the effects of age, sex, region, insurance plan, and Elixhauser comorbidities.
Results: Compared to patients living in areas with mean income ?$65,000, those from areas with mean income <$65,000 had a higher incidence of any ED utilization at both 7 and 30 days postoperatively, for both elective hand and distal radius fracture surgeries (all p<0.001). As mean area income increased, there was a trend towards fewer ED visits (Figure). In the multivariable analysis, the incidence of ED utilization at 7- and 30-days postoperatively was inversely correlated with mean area income (Table). With every $10,000 increase in mean area income, there was an estimated decrease in the odds of an ED visit by 5-6%.
Conclusions: Mean area income was inversely associated with ED utilization after elective hand and distal radius fracture surgeries. These results highlight the influence of socioeconomic factors on post-hand surgery care, presenting an opportunity for intervention (e.g., close monitoring of at-risk patients via perioperative telehealth programs). Further research is needed to investigate the etiology of this disparity and to identify the contributing patient (e.g., disparities in preoperative health status) and social (e.g., reduced access to healthcare facilities) factors.
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