Investigating factors associated with postmastectomy emergency department visits: A population-based analysis.

Abstract

241 Background: In 2016, a multi-pronged pathway was implemented in 13 hospitals across the province of Alberta, Canada to improve the mastectomy perioperative care experience focused on two objectives: 1) to increase same day surgery mastectomy rates and 2) decrease the number of unnecessary postoperative ED visits. The pathway successfully increased same day mastectomy rates from 1.7% to 47.8%, however the rate of postoperative ED visits remained high at 22-27%, a rate several-fold greater than described at other centers (3.1-12.8%) in spite of focused interventions at the patient and provider level to enhance perioperative support. Objective: To investigate potential factors associated with high postoperative ED visits following mastectomies in Alberta, Canada. Methods: Data was collected using the Discharge Abstract Database, and the National Ambulatory Care Reporting System database. Eligible patients included all women over 18 years old who underwent a mastectomy in the province of Alberta between 2004 and 2018. Patient demographics and operative variables including age, SES, Charlson comorbidities, date of surgery, surgery type (same-day vs. overnight) and health regions were collected. Primary outcome of interest was an ED visit within 30 days of mastectomy. Univariate and multivariate analyses were performed to identify independent predictors for post-operative ED visits. Results: A total of 18,076 patients had mastectomy during the study period, of which 4219 (23.3%) had an ED visit within 30 days of surgery. The most common causes of ED visits were infection, pain, and nausea/vomiting. Independent factors associated with ED visits were increasing age, overnight stay mastectomy, having reconstruction, cerebrovascular disease, chronic pulmonary disease, peptic ulcer disease, diabetes, depression, and living rurally. There was a slight decrease in ED visits post-implementation of the perioperative pathway (21.6% vs. 23.7%) but it was not statistically significant in the multivariable analysis. Conclusions: Post-operative ED visits remain high despite initiating a province-wide surgical pathway in 2016 which emphasizes patient education and improved perioperative care and supports. ED visits are associated with geographic location, specific comorbidities, and overnight stays. Currently, the majority of ED visits are manageable in non-emergent settings. Further investigations are necessary to discern whether additional perioperative interventions can curb the high ED visit rate.