Abstract
Background
Emergency department (ED) overuse is a large contributor to healthcare spending in the USA. We examined the rate of and risk factors for ED visits following outpatient breast cancer surgery.
Patients and Methods
Using linked data from the Surveillance, Epidemiology, and End Results (SEER) program and Medicare, we identified women who underwent curative breast cancer surgery between 2003 and 2015. Our outcome of interest was ED visits within 30 days of surgery. Multivariate regression was used to evaluate the odds of ED visit while controlling for clinical and socioeconomic variables. Secondary analyses assessed admission from the ED as well as costs.
Results
Of the 78,060 included patients, 5.1% returned to the ED, of which only 29.8% required hospital admission. Rate of ED visits increased with patient age. A higher percentage of Black patients returned to the ED compared with white patients (7.0% versus 5.0%, p < 0.001). Patients with higher income were less likely to visit the ED compared with those with lower income (OR 0.76, p < 0.001). Predictors of ED visits included: being unmarried (OR 1.18, p < 0.001), having stage 2 (OR 1.20, p < 0.001) or stage 3 cancer (OR 1.38, p < 0.001), and those with Charlson comorbidity score of 1 (OR 1.39, p < 0.001) or ≥ 2 (OR 2.29, p < 0.001).
Conclusion
While a substantial number of patients return to the ED following outpatient breast surgery, most do not require hospital admission, which indicates that a large proportion of these visits could have been avoided. We identified several clinical and socioeconomic predictors of postoperative ED visits, which will aid in the development of patient risk profiling tools.
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Funding
This study was supported by the Cancer Prevention and Research Institute of Texas (CPRIT) (grant no. RP160674 to S.H.G.), by the Susan G. Komen Breast Cancer Foundation (grant no. SAC150061 to S.H.G.), and by the National Institutes of Health/National Cancer Institute through Cancer Center Support Grant P30CA016672.
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Sun, S.X., Duan, Z., Kuerer, H.M. et al. Predictors of Emergency Room Visits After Ambulatory Breast Cancer Surgery in the Medicare Population. Ann Surg Oncol 30, 1689–1698 (2023). https://doi.org/10.1245/s10434-022-12836-y
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DOI: https://doi.org/10.1245/s10434-022-12836-y