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

Abstract

Study Objective We aimed to identify the prevalence of emergency department (ED) visits following outpatient gynecologic surgery. Additionally, we aimed to identify patients at highest risk for ED visits. Design Retrospective cohort study. Setting Academic medical center. Patients or Participants Women (n=2,373) age 18 and older who underwent scheduled outpatient gynecologic surgery for a benign indication between November 2017 and September 2019. Interventions Any gynecologic surgery performed for benign indications. Measurements and Main Results We extracted demographic, clinical, and perioperative characteristics from the medical record. The primary outcome was evaluation at our institution's ED within 30 days of surgery. Patients who visited the ED, as compared to those who did not, were younger (median age 37 vs. 42, p=.02) and were more likely to have a history of abdominal surgery (67% vs. 56%, p=.02) or cardiopulmonary comorbidity (53% vs. 40%, p=.007). Additionally, patients who underwent intra-abdominal as opposed to vulvovaginal surgery (50% vs. 44%, p=.04) or who experienced a postoperative complication (9% vs 4%, p=.005) were more likely to visit the ED. A total of 109 (5%) patients visited our institution's emergency room 125 times within thirty days of surgery. Forty-five (36%) ED visits resulted in admission. When adjusted for ASA class, chronic pain comorbidities, procedure performed, operative time, blood loss, and attendance at a postoperative clinic visit, the following factors were associated with significantly increased or decreased odds of visiting the emergency room in multivariate analysis: increasing age (aOR 0.5; 95% CI 0.3-0.7), cardiopulmonary comorbidities (aOR 1.9; 95% CI 1.2-3.0), and undergoing prolapse surgery as opposed to other non-hysterectomy vulvovaginal procedures (aOR 0.2; 95% CI 0.1-0.6). Conclusion Emergency department visits were uncommon after outpatient gynecologic surgery but approximately one third resulted in admission. Increased counseling of younger patients and optimization of cardiopulmonary comorbidities may help reduce this burden.