Prevalence of and Risk Factors for Emergency Department Visits After Outpatient Gynecologic Surgery

Abstract

To identify the prevalence of and risk factors for emergency department (ED) visits within 30 days of outpatient gynecologic surgery. Retrospective cohort study. Tertiary academic medical institution. Adult patients who underwent outpatient surgery (≤1 midnight in the hospital) between January 2018 and September 2019 (n=2,373). Scheduled, outpatient gynecologic surgery for a benign indication. 109 (5%) patients visited the ED within 30 days of surgery. Patients who visited the ED were significantly younger (median age 37 vs. 42, p=.02) and had a higher prevalence of abdominal surgical history (67% vs. 56%, p=.02) and cardiopulmonary comorbidities (53% vs. 40%, p=.007). They were more likely to have had a hysterectomy (26% vs. 20%) and less likely to have had prolapse surgery (4% vs. 12%, p=0.05). Pain related to the surgical site (42% of ED visits), nausea and/or vomiting (14%), and fever (12%) were the most common surgery-related reasons for ED visits. Medical issues not directly related to surgery accounted for 31% of ED visits. 36% of ED visits resulted in admission. When adjusted for age, insurance status, ASA class, chronic pain and cardiopulmonary comorbidities, abdominal surgical history, primary procedure performed, and surgical route, the following factors were associated with significantly increased risk of visiting the ED: decreasing age (aOR 1.2, 95% CI 1.1-1.3, p<.001), abdominal surgical history (aOR 1.7, 95% CI 1.1-2.6, p=.017), cardiopulmonary comorbidities (aOR 1.9, 95% CI 1.2-3.0, p=.003), undergoing hysterectomy (aOR 2.0, 95% CI 1.1-3.8, p=0.032), and a vulvovaginal as opposed to abdominal surgical route (aOR 2.4; 95% CI 1.2-5.1, p=0.015). ED visits following outpatient gynecologic surgery were uncommon, although approximately one third of visits resulted in admission. Strategies that target our identified risk factors of younger patient age and cardiopulmonary comorbidities may help reduce the ED burden generated by gynecologic surgery patients.