Characterizing 30-Day Postoperative Acute Care Visits: A National Surgical Quality Improvement Program Collaborative Analysis.

Abstract

Many postoperative acute care visits (PACVs) are likely more appropriately addressed in lower acuity settings; however, the frequency and nature of PACVs are not currently tracked by the National Surgical Quality Improvement Program (NSQIP), and the overall burden to emergency departments and urgent care centers is unknown. NSQIP collaborative data were augmented to prospectively capture 30-d PACVs for 1y starting October 2018 across all NSQIP specialties, including visit reason and disposition. Data were analyzed using binomial logistic regression. A total of 9933 patients were identified; 12.0% (n=1193) presented to an acute care setting over 1413 visits, most commonly for surgical pain (15.4%) in the absence of an identified complication. Visits most commonly resulted in discharge (n=817, 68.5%) or admission (n=343, 24.3%). Variables independently associated with visits resulting in discharge included age (odds ratio [OR] 0.99 per year, P<0.001), increasing comorbidities (1-2 [OR 1.55, P<0.001]; 3-4 [OR 2.51, P<0.001]; 5+ [OR 2.79 P<0.001]), operative duration (OR 1.08 per hour, P=0.001), and nonelective (OR 1.20, P=0.01) or urologic (OR 1.46, P=0.01) procedures. PACVs are an overlooked burden on emergency medicine providers and healthcare systems; most do not require admission and could be potentially triaged outside of the acute care setting with improved perioperative care infrastructure. Younger patients, those with multiple comorbidities, and those undergoing nonelective procedures deserve special attention when designing initiatives to address postoperative acute care utilization. Data regarding PACVs can be routinely collected with minor modifications to current NSQIP workflows.