Evaluation of Emergency Department Utilization Within 30 Days of Same-Day Gynecologic Surgery at a Mid-Atlantic Teaching Hospital

Abstract

Objective: Hospital readmission rates and unscheduled patient contacts, such as in the emergency department (ED), are frequent quality measures for hospitals and surgical centers. This study identified complaints leading patients to present to the ED within 30 days of same-day gynecologic surgery as well as possible interventions to decrease the rate of those visits. Materials and Methods: At a tertiary-care center with a level I trauma service and dedicated women's hospital, this retrospective chart review covered all cases of women over 18 who had same-day discharge gynecologic surgery and presented to the ED within 30 days of that discharge. Data were collected regarding chief complaint(s), ED workups, management, and dispositions. A χ2 test was used to determine the significance of categorical variables. Results: Of 1880 same-day discharge gynecologic surgeries, there was a 3.5% 30-day ED presentation rate. Top 5 complaints were: (1) pain; (2) subjective fevers/chills; (3) vaginal bleeding; (4) urinary symptoms; and (5) shortness of breath. There was a statistically significant difference in postoperative ED-visit rates in gynecologic surgery defined by the study (p = 0.03). Conclusions: The current authors' hospital system overall had postoperative ED visits at a rate consistent with previously published data. This study highlighted the need for improvement in specific areas, such as improved postoperative pain management, treatments to reduce urinary symptoms, patient education on normal postoperative vaginal bleeding, and communication on bleeding precautions. (J GYNECOL SURG 20XX:000)