Emergency Department Visit Rates Research Articles

Same Day Discharge After Robotic Radical Prostatectomy.

This review evaluates the current landscape of same-day discharge (SDD) following robotic-assisted laparoscopic prostatectomy (RARP), highlighting perioperative management strategies and proposing future research directions. RARP has been shown to improve perioperative outcomes including reduced blood loss, postoperative pain, and hospital length of stay (LOS) when compared to open radical prostatectomy. Recently, the question of the feasibility of SDD for RARP has been proposed, aiming to reduce postoperative complications, hospital-acquired infections, and healthcare costs. The advent of single-port robotic systems aims to further minimize postoperative morbidity. Recent literature has reported SDD for RARP is safe and feasible in appropriately selected patients, with postoperative outcomes, including complication and readmission rates, similar to inpatient RARP. Our findings show SDD can be safely implemented without compromising patient outcomes, as evidenced by similar complication, readmission, and emergency department visit rates compared to inpatient cohorts. Future research should be aimed to refining patient selection criteria, enhancing opioid-free anesthesia pathways, and exploring new surgical technologies to improve SDD outcomes.

Does a provider contact wristband lower ED visit rates following hip or knee arthroplasty?

Reducing unnecessary emergency department (ED) visits following joint arthroplasty is an important goal. Literature suggests 30-day visit rates range between 4% and 15%, with only 20%-25% of these admitted for care. Low admissions suggest an opportunity to reduce unnecessary postarthroplasty ED visits. This study examined whether a wristband would encourage patients to call the care team with concerns prior to going to the ED. A wristband displaying a contact phone number was placed on patients at discharge. ED visit rates (30 and 90 days) and readmissions (90 days) were tabulated for 2years prior to and up to 3years after the implementation of the wristband program. Residents who responded to calls and call logs were also reviewed. At 2 years after implementation, a total of 1023 joint replacements produced 273 calls or 1 call per 3.75 patients. Nearly half (48.1%) of the calls were received during weekday work hours when the patients had been directed to call the office. While ED visits declined after the implementation of the wristband at both 2 and 3 years, these reductions were not statistically significant (30 days: 5.1% before, 4.1% after; 90 days: 8.1% before, 7.1% after). There was a significant reduction in 90-day readmissions (6.4% before, 4.0% after). Patients utilized the wristband number, but this did not significantly reduce the number of ED visits within 3 years. Future studies should track ED visits and identify decision-making factors behind ED use in order to find ways to improve the intervention.

Causes of hospitalization and mortality in persons with epilepsy: The EpiLink Bologna cohort, Italy.

Epilepsy significantly impacts on morbidity and mortality. Understanding hospitalization and mortality risks in persons with epilepsy (PWE) is essential for improving healthcare strategies. We aimed to investigate the risk and causes of hospitalization and mortality in PWE compared to a matched general population cohort. The EpiLink Bologna historical cohort study analyzed adult PWE in the period 2018-2019. A general population control cohort was used for comparison. Clinical data were linked with health administrative data. PWE were grouped into persons with focal epilepsy, idiopathic generalized epilepsy, and developmental and/or epileptic encephalopathy (PDEE). The primary outcome was the hospitalization rate. Emergency department (ED) visit rate and the risk of death for any cause were also assessed. The study included 1438 PWE and 14,096 controls. PWE had higher incidence rate ratio (IRR) for ED visit (IRR 1.26, 95% CI 1.20-1.32), hospital admission (IRR 2.05, 95% CI 1.83-2.29), and death (IRR 1.5, 95% CI 1.1-2.2) compared to control cohort. The highest hospitalization risk was in the PDEE group (IRR 4.70; 95% CI 3.28-6.74). The increased hospitalization rate among PWE was due to both their higher ED visit and elective hospital admission rates. PWE on polytherapy were at higher risk of hospitalization for inflammation of jaw, acid-base/electrolyte imbalances, chronic cerebrovascular disease, major traumas and infections. During a 2-year-period, PWE in Bologna had a doubled risk of hospitalization and 50% higher risk of death compared to a matched general population cohort. Hospitalization risks varied significantly by epilepsy type and antiseizure therapy.

Source specific fine particles and rates of asthma and COPD healthcare encounters pre- and post-implementation of the Tier 3 vehicle emissions control regulations

We examined associations between seven source-specific PM2.5 concentrations and rates of asthma and COPD hospitalizations and emergency department (ED) visits in New York State and compared the changes in excess rates (ERs) between pre- (2014-2016) and post-implementation (2017-2019) of the Tier 3 automobile emission controls on new vehicles policy. A modified time-stratified case-crossover design and conditional logistic regression were employed to estimate the ERs of asthma and COPD hospitalizations and ED visits associated with interquartile range (IQR) increases in source-specific PM2.5 concentrations. The seven PM2.5 sources were spark-ignition emissions (GAS), diesel (DIE), biomass burning (BB), road dust (RD), secondary nitrate (SN), secondary sulfate (SS), and pyrolyzed organic rich (OP). Residual PM2.5 (PM2.5 – specific source [e.g., GAS]), daily temperature, relative humidity, weekday, and holidays were included in the model. IQR increases in GAS, SS, RD, BB, and SN were associated with increased ERs of asthma ED visits (highest ERs: 0.5%-3.1%), while a negative association was observed with DIE and OP. The rate of asthma hospitalizations was associated with increased RD concentrations (ERs: 1.3%-1.7%). Both COPD ED visit and hospitalization rates were associated with increased OP (ERs: 2.1%-3.4%), and increased SS was positively associated with COPD ED visits (ER = 3.8%). In summary, after Tier 3 implementation (2017-2019), we found lower ERs for COPD admissions associated with BB, RD, SN, and SS compared to 2014-2016. However, rates of asthma ED visits associated with source-specific PM2.5 concentrations were generally higher for all sources, except DIE, post- versus pre-implementation, requiring further research for validation.

375. Back to School Unequal: Neighborhood Disadvantage and Asthma-related Emergency Department Visits in School-Aged Children

Abstract Background Asthma-related emergency department (ED) visit rates among children in a typical year closely follow the school calendar, with a sharp increase in rates when students return to school. The well-known increase in asthma exacerbations at the start of the school year is largely attributable to increases in respiratory viral infection. Because neighborhood disadvantage is strongly tied to asthma exacerbations, we hypothesized that greater neighborhood disadvantage would be associated with a greater increase in the rate of asthma exacerbations after the start of school. Methods We summarized Texas Health Care Information Collective data (2016-2019) on asthma-related ED visits among children (ages 5-17) in four Texas metropolitan statistical areas (Houston, Dallas, Austin, and San Antonio) by week and census tract. Neighborhood disadvantage was characterized at the census-tract level using tertiles of Social Vulnerability Index (SVI), percent uninsured, and percent living below the federal poverty line. Within each tertile, we described population-based incidence rates of asthma-related ED visits per 100,000 person-years in the 6 weeks before and after the week that school started. We also modeled weekly incidence rates and pointwise 95% confidence intervals by week using a locally weighted smoothing model. Results Comparing the 6-week periods before and after the week that school started, the incidence rate of asthma-related ED visits in high-, medium-, and low-SVI census tracts increased by 60, 39, and 20 cases per 100,000 person-years, respectively, representing a 3-fold difference between high- and low-SVI census tracts. Census tracts with high SVI had the greatest modeled increase in weekly rates of asthma-related ED visits after the start of school (Figure 1). Results were qualitatively similar for the percent of the population uninsured and below the federal poverty line (Figures 2-3). Conclusion Greater neighborhood disadvantage was associated with a greater increase in the rate of asthma related ED visits after the start of school, suggesting that neighborhood disadvantage may contribute to exacerbation risk by increasing the risk of respiratory virus infection. Disclosures Paul Rathouz, PhD, Sunovion Pharmaceuticals: DSMB Member

P-1884. Evaluation of Outpatient Parenteral Antimicrobial Therapy Practices within a Large Healthcare System

Abstract Background The practice of outpatient parenteral antimicrobial therapy (OPAT) has challenges such as reduced control and monitoring in the outpatient setting. Lack of availability of OPAT lab monitoring is associated with poorer outcomes. This study sought to describe the operations and practices of an OPAT program within a large health system to identify clinical and operational opportunities for workflow improvement. Laboratory monitoring completion over proportion of OPAT courses Methods This was a retrospective cohort study of patients receiving OPAT in a large healthcare system from January 1, 2022 to December 31, 2022. After excluding OPAT courses initiated in the outpatient setting and courses less than 7 days long, 200 OPAT courses for patients greater than 18 years of age were selected, using a random sample generator, from the Cleveland Clinic OPAT registry. Events were followed until the OPAT end date or 30 days, whichever occurred sooner. The relationship between lab monitoring completion within 24 hours of scheduled date and detection of clinically significant lab abnormalities (CSLAs) was examined using linear regression. Secondary outcomes included the rate of emergency department (ED) visits and readmissions. Cumulative incidence of ED visits by target lab monitoring level Results The mean age (SD) of included patients was 63 years (27) and 64% were male. Fewer than half the OPAT courses had 80% or higher lab monitoring completion (Figure 1). Detected CSLAs are shown in Table 1. In a linear regression model adjusted for high-risk medications, the number of CSLAs detected per OPAT course increased by 0.003 (95% C.I. 0.002 – 0.004) per unit increase in percentage lab monitoring completion (p < 0.001). ED visit within 30 days was 11% (Figure 2) and readmission within 30 days was 23% (Figure 3). Reasons for readmission included non-OPAT-related (53%, n=24 of 45), infection-related (40%, n=18 of 45), and adverse OPAT drug effects (9%, n=4 of 45). Cumulative incidence of readmissions by target lab monitoring level Conclusion This study showed a substantial gap in lab completion and a significant association between lab monitoring completion and detection of CSLAs, thereby demonstrating clinical and operational opportunity for OPAT workflow improvement with monitoring and follow-up actions. A multidisciplinary OPAT team with clearly defined roles may enhance safety, effectiveness, and efficiency within the program. Detection of Clinically Significant Lab Abnormalities Disclosures Andrea Pallotta, PharmD, Astra Zeneca: Advisor/Consultant|Viiv: Advisor/Consultant

Comparison of Clinical Outcomes Between Two Types of Dipeptidyl Peptidase-4 Inhibitors in Posttransplant Diabetes Mellitus in Kidney Transplantation Recipients: A Nationwide Population-Based Cohort Study in Korea.

Dipeptidyl peptidase-4 inhibitors (DPP-4i) are antidiabetic drugs known for their minimal side effects and limited drug interaction witih immunosuppressants, making them suitable for patients with diabetes and kidney transplant recipients. However, there is limited real-world information regarding the use of DPP-4 inhibitors in patients with post transplant diabetes mellitus (PTDM). We performed a retrospective observational cohort study of 13,828 kidney transplant recipients form Janary 1, 2002, through December 21, 2018, using the Korean National Health Information Database. We extracted PTDM patients, and divided the patients into 2 groups baased on whether they received DPP4-inhibitor which needs dose adjustement (group A) or not (Group B) according to estimaged glomerular filtration rate. Out of 3154 patients who developed PTDM after transplantation, 738 patients prescribed DPP-4 inhibitors. Among these, 490 patients prescribed Group B DPP-4 inhibitors and 238 patients prescribed Group A DPP-4 inhibitors. Multivariate-adjusted Cox regression analysis showed that compared Group B, Group A DPP-4 inhibitors was associated with higher incidence rate of genital tract infection (hazard ratio (HR) 1.87, 95% Confidence Interval (CI) 1.18-2.99), and emergency department visit (HR 3.12, 95% CI 1.89-5.16). However, there was no significantly difference in death (any cause), admission, graft failure, infection, or hypoglycemia between the 2 groups. In patients with PTDM, some kinds of DPP-4 inhibitors, which need dose adjustment according to renal function, were associated with an increased rate of emergency department visit and genital tract infection.

Addressing the overuse of hospital emergency departments in the Portuguese NHS: a new paradigm.

The escalating trend of inappropriate visits to Emergency Departments (ED) has led to significant concerns, including resource misallocation, compromised patient care, and an increased burden on healthcare workers. Portugal faces a notable challenge, reporting one of the highest per capita ED visit rates, with an annual average of approximately 6 million ED visits from 2013 to 2023. In response, the "Call First, Save Lives" pilot project was launched by the Portuguese NHS Executive Board, in 2023, at the Local Health Unit (LHU) of Póvoa de Varzim/Vila do Conde. This project leverages the SNS 24 telephone triage system to direct patients to the most appropriate care settings, alleviating pressure on ED, and optimizing healthcare resources. The project introduced several strategic enhancements, including optimizations of the SNS 24 system and inter-institutional initiatives to promote interoperability, hospital follow-ups for chronic conditions, and a "reverse referral" system directing non-urgent ED cases to Primary Care Services (PCS). In PCS, the project expanded acute care consultations and introduced complementary health services. The initiative also emphasized communication to improve health literacy and appropriate utilization of the NHS, supported by legal framework development. Since the beginning of the project, the number of calls received by SNS 24 showed an upward trend, both at the local, 27.6%, and national level, 44.5%, having already expanded to other LHU. Nonetheless, challenges such as the "reverse referral" process complexity, healthcare information systems integration, and procedural standardization need addressing, with future plans including satisfaction surveys and patient triage protocol refinements to improve service delivery and patient adherence.

Post-Telemedicine Acute Care for Undifferentiated High-Acuity Conditions: Is a Picture Worth a Thousand Words?

Objectives: Telemedicine use increased substantially with the COVID-19 pandemic. Understanding of the impact of telemedicine modality (video vs. phone) on post-telemedicine acute care for higher risk conditions is limited. Methods: We conducted a retrospective study of telemedicine visits, comparing video with telephone, for selected diagnoses with potentially higher illness acuity, evaluating post-telemedicine emergency department (ED) and hospitalization rates. In a large, multicenter cohort of adult patient-initiated primary care telemedicine visits from March 1, 2020, to July 31, 2021, we evaluated 7-day ED and hospitalization rates for higher acuity diagnostic categories (cardiac, gastrointestinal, and respiratory) by telemedicine modality, provider familiarity, and patient sociodemographic and clinical characteristics. Results: Among 431,705 telemedicine encounters, 128,129 (29.7%) were video visits and 303,576 (70.3%) were telephone visits. Adjusting for patient and appointment factors, telephone encounters for cardiac conditions were associated with significantly higher 7-day ED visit rates than video encounters (5.5% vs. 4.9%, respectively) but similar hospitalization rates (0.7% vs. 0.8%, respectively); for gastrointestinal conditions, post-telemedicine adjusted ED and hospitalization rates were comparable between telemedicine modalities (4.0% for ED and 1.2% vs. 1.3% for hospitalization, respectively); among respiratory conditions, video encounters were associated with higher ED and hospitalization rates than telephone encounters (ED: 5.9% after video vs. 5.2% after phone; hospitalization: 1.9% after video vs. 1.5% after phone). Telemedicine encounters with patients' own primary care provider (PCP) were associated with lower adjusted rates of ED use across all conditions and modalities. Conclusions: Short-term ED and hospitalization rates following primary care video or telephone visits for selected acute, high-risk conditions varied by condition and PCP familiarity. Nuanced use of video visits may confer benefits triaging to downstream acute care.

Impact of the COVID-19 Pandemic on Emergency Department Visits for Idiopathic Facial Nerve Palsy: An Interrupted Time-Series Analysis

This study evaluated the impact of the COVID-19 pandemic and related social restrictions on emergency department (ED) visits for idiopathic facial nerve palsy (IFNP). A retrospective observational analysis was conducted on a consecutive cohort of patients presenting to a hospital ED from January 1, 2015, to December 31, 2021. Monthly ED visit rates for IFNP were compared before and after the onset of the pandemic and the national lockdown in March 2020 using interrupted time-series analysis. Data were standardized to 1,000 ED visits per month. Among 248,606 total ED visits during the study period, 266 (0.11%) were due to IFNP. No significant change in standardized ED visits for IFNP was observed immediately following the pandemic’s onset (1.08/1,000 visits; 95% CI: -0.06 to 2.23; p=0.063). However, a significant reduction in visit rates was noted in the months following March 2020 (-0.08/1,000 visits; 95% CI: -0.15 to -0.002; p=0.043). The decline in IFNP ED visits likely reflects the protective effects of social distancing measures, face mask usage, and reduced viral transmission during the pandemic. These findings challenge claims of increased IFNP risk associated with SARS-CoV-2 infection or vaccination. Furthermore, the results support the hypothesis that neurotropic viruses contribute to the pathogenesis of IFNP and highlight the role of public health measures in reducing disease incidence. This study provides novel insights into the indirect benefits of pandemic-related interventions on viral-associated conditions such as IFNP.

The Influence of Project ECHO and Integrated Behavioral Health in Primary Care on Emergency Department Visits Among Youth Diagnosed with Depression.

Rates of depression among youth and emergency department (ED) visits for un- or under-treated symptoms are on the rise. Early identification and treatment of depression is imperative at the patient, program, system, and population levels. This paper examines the individual and cumulative impact of Project ECHO and the inclusion of IBH services in pediatric primary care practices on mental health-related ED rates among youth diagnosed with depression for those practices. Twenty-eight practices participated and provided data on 5,388 patients diagnosed with depression who were seen between 2019 and 2022. A binominal mixed effect model was used to examine the impact of Project ECHO and IBH on mental health-related ED rates among youth diagnosed with depression per month within each practice. Compared to practices without an IBH program, those who implemented IBH had a significantly lower rate of mental health-related ED visits among this patient population (Incident Rate Ratio (IRR) = 0.80, p = .005, 95% Confidence Intervale (CI) = 0.68, 0.93). No significant differences were found between practices regardless of participation in Project ECHO, nor was there a significant interaction effect between practices that employed Project ECHO and IBH in combination. This study shows promising results with IBH having a positive impact on practice outcomes compared to treatment as usual, while Project ECHO in isolation or combined with IBH did not significantly affect rates of mental health-related ED visits.

Age, period and cohort processes in chronic obstructive pulmonary disease related emergency department visit rate in Taiwan, 2001-2015.

Emergency room (ER) physicians must deal with patients with clinically suspected symptoms, such as dyspnea, cough, and increased sputum production, on the frontlines of medical care if patients present with severe chronic obstructive pulmonary disease (COPD). This study aims to investigate the longitudinal tendencies of COPD-related ER visits. A total of 360,313 patients were included in this study. The COPD-related ER visit rates between 2001 and 2015 were categorized using the International Classification of Disease (ICD) codes (496). The effects of age, period, and cohort on COPD-related ER visit rates were determined using an age-period-cohort (APC) model. Age was associated with a high risk of COPD in the pediatric and older populations. A significant increase was observed in the period effect, from 2001 to 2015. The cohort effect tended to oscillate from 1918 to 1973, and was reversed in the latest cohort. Furthermore, the COPD-related ER visit rate increased between 2001 and 2015 in both men and women. Age, period, and cohort were observed to increase COPD visit rates. The APC model can be used to determine trends in COPD-related ER visits.

Investigation of geographic disparities and temporal changes of non-gestational diabetes-related emergency department visits in Florida: a retrospective ecological study.

Rates of diabetes-related Emergency Department (ED) visits in Florida increased by 54% between 2011 and 2016. However, little information is available on geographic disparities of ED visit rates and how these disparities changed over time in Florida and yet this information is important for guiding resource allocation for diabetes control programs. Therefore, the objectives of this study were to (a) investigate geographic disparities and temporal changes in non-gestational diabetes-related ED visit rates in Florida and (b) identify predictors of geographic disparities in non-gestational diabetes-related ED visit rates. The ED data for the period between 2016 and 2019 were obtained from the Florida Agency for Healthcare Administration. Records of non-gestational diabetes-related ED visits were extracted using the International Classification of Diseases (ICD)-10 codes. Monthly non-gestational diabetes-related ED visit rates were computed and temporal changes were investigated using the Cochran-Armitage trend test. County-level non-gestational diabetes-related ED visit rates per 100,000 person-years were calculated and their geographic distributions were visualized using choropleth maps. Clusters of counties with high non-gestational diabetes-related ED visit rates were identified using Kulldorff's circular and Tango's flexible spatial scan statistics. Predictors of non-gestational diabetes-related ED visit rates were investigated using negative binomial model. The geographic distributions of significant (p ≤ 0.05) high-rate clusters and predictors of ED visit rates were displayed on maps. There was a significant (p < 0.001) increase in non-gestational diabetes-related ED visit rates from 266 visits per 100,000 person-months in January 2016 to 332 visits per 100,000 person-months in December 2019. Clusters of high non-gestational diabetes-related ED visit rates were identified in the northern and south-central parts of Florida. Counties with high percentages of non-Hispanic Black, current smokers, uninsured, and populations with diabetes had significantly higher non-gestational diabetes-related ED visit rates, while counties with high percentages of married populations had significantly lower ED visit rates. The study findings confirm geographic disparities of non-gestational diabetes-related ED visit rates in Florida with high-rate areas observed in the rural northern and south-central parts of the state. Specific attention is required to address disparities in counties with high diabetes prevalence, high percentages of non-Hispanic Black, and uninsured populations. These findings are useful for guiding public health efforts geared at reducing disparities and improving diabetes outcomes in Florida.

Unplanned Postoperative Emergency Department Visits After Upper Extremity Fracture Surgery.

This study aimed to determine whether outpatient upper extremity fracture surgery was associated with increased postoperative emergency department (ED) visits and identify related risk factors. Retrospective cohort. This multicenter study was conducted within a single academic institution, encompassing two Level 1, two Level 2, and one Level 3 trauma centers. All patients >18 years of age who underwent upper extremity fracture surgery from 2015 to 2021 were included. Risk factors for postoperative ED visit that were investigated included age, sex, tobacco use, alcohol abuse, psychiatric diagnosis, Elixhauser comorbidity score, race, location of upper extremity fracture, surgical setting (inpatient vs. outpatient), upper extremity block, surgical specialty, and Area Deprivation Index. Variables with a P < 0.1 in bivariate analysis were included in a multivariable logistic regression to determine factors associated with a postoperative ED visit at 30 and 90 days. A total of 6315 patients with an average age of 51 ± 19 years were identified of whom 52% were women and 65% had outpatient surgery. Postoperatively, 188 patients (3.0%) presented to the ED within 30 days and 304 (4.8%) presented within 90 days. Thirty-seven percent of ED visits were directly related to the procedure, most commonly for pain (20%), cast issues (4.3%), and swelling (3.9%). At 30 days postoperatively, 2.8% of patients who underwent surgery in an outpatient setting and 3.4% of those who underwent inpatient surgery returned to the ED, with these rates increased to 4.4% and 5.6%, respectively, by 90 days. In multivariable analysis, outpatient surgery (odds ratio [OR]: 1.5, P = 0.030), tobacco use (OR: 2.1, P < 0.001), higher Elixhauser comorbidity scores (OR: 1.2, P < 0.001), non-White race (OR: 1.9, P < 0.001), elbow fractures (OR: 1.8, P = 0.016), and hand fractures (OR: 1.6, P = 0.046) were associated with 30-day ED visits. Outpatient surgery was associated with increased rate of 30-day ED visits. Patients who smoke, had increased number of comorbidities, or were non-White presented to the ED more frequently. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Emergency Department Visits After Total Joint Arthroplasty in a Closed Urban Setting: A Report of 1,000 Consecutive Cases.

Rates of emergency department (ED) visits and readmissions after total joint arthroplasty (TJA) have been cited as indicators of TJA quality. Understanding the incidence and nature of these events is critical for prevention. The purpose of this study was to analyze readmission rates 30 and 90 days after TJA at a safety-net hospital in an urban setting and to compare this readmission rate with that for non-safety-net hospitals found in the current literature. In addition, we aimed to quantify the readmissions in our safety-net hospital that led to future complications. This would help us identify if there is a high incidence of preventable readmission rates in this unique socioeconomic environment. Using our institutional electronic medical record system, we retrospectively studied 1000 consecutive TJA encounters between 2014 and 2019 to determine the rates of treat-and-release ED visits within 30 and 90 days after surgery. The ED charts were reviewed, and patients who returned to the operating room (OR) for a TJA complication within 1 year of surgery were identified. We compared the OR return rates of people who had ED visits with those in the control group. A total of 110 (11%) and 191 (19.1%) patients visited the ED within 30 and 90 days of surgery, respectively. Fisher exact test confirmed that having an ED visit within 90 days of TJA because of lower extremity pain and/or swelling or a social issue was associated with returning to the OR within a year of TJA. Having an ED visit within 30 or 90 days of total hip replacement was associated with returning to the OR for total hip replacement complications. ED visits after TJA at an urban safety-net hospital were markedly higher than those reported in the literature for nonurban safety-net hospitals. In addition, postoperative ED visits for specific diagnoses may predict complications. This indication may have implications for a risk adjustment in programs such as bundled payments. Our results also indicate overutilization of the ED by avoidable ED visits. This represents a call for alternatives to the ED for patients after TJA in environments served by safety-net hospitals.

Statin Use is Associated with Decreased Venous Thromboembolism Events Following Total Hip Arthroplasty: A Matched Retrospective Cohort Study.

Despite advances in surgical techniques and postoperative prophylactic protocols, venous thromboembolism (VTE) events remain an important source of morbidity following total hip arthroplasty (THA). Prior research in cardiology and other surgical fields has suggested that statin medications may have a protective effect against VTE. Our study aimed to: 1) Assess if preoperative statin use was associated with decreased rates of VTE following THA, and 2) conduct a subgroup analysis of statin intensity and VTE events. A total of 1,154 patients who had preoperative statin use for at least four weeks before surgery and who underwent primary THA at a large, urban academic center between January 1, 2012, and June 1, 2023, were identified. The 90-day postoperative VTE events, deep vein thrombosis (DVT), pulmonary embolism (PE), emergency department (ED) visits, reoperations, and readmission rates were collected from institutional coding software. Mortality rate in the 90-day postoperative period was also measured. Propensity matching was used to control for demographics and selected comorbidities. Preoperative statin use was associated with significantly lower rates of 90-day VTE events (Statin: 0.43% versus No-Statin: 1.13%, P = 0.047). There were no significant differences in 90-day PE, DVT, ED visit, readmission, or reoperation rates. There were no deaths within 90 days of THA in either group. Subgroup analysis of statin intensity revealed no significant differences in any outcomes measured between high-intensity, medium-intensity, and low-intensity statin groups. Preoperative statin use is associated with significantly lower rates of VTE events in the 90-day postoperative period following THA. Further research into the effect of statins on post-THA VTE is warranted.

Socioeconomic position, alcohol use and alcohol-attributable emergency department visits.

Differential vulnerability to alcohol contributes to socioeconomic inequities in alcohol-attributable harm. This study aimed to estimate the sex-/gender-specific joint effects of socioeconomic position (SEP) and heavy episodic drinking or volume of alcohol use on 100% alcohol-attributable emergency department (ED) visits. We conducted a cohort study among 36 900 men and 39 700 women current and former alcohol consumers aged 15-64 from population-representative Canadian Community Health Surveys (2003-2008) linked to administrative ED visit data through 2017 in Ontario and Alberta. We estimated sex-/gender-specific associations between SEP (both education and income) and heavy episodic drinking (≥5 standard drinks on one occasion, at least monthly) or volume of alcohol use (standard drinks per week) on incident alcohol-attributable ED visits and assessed additive interactions using the Synergy Index (S). Lower levels of education (eg, less than high school vs Bachelor's degree or above: men: adjusted HR (aHR)=3.71, 95% CI 2.47 to 5.58; women: aHR=1.75, 95% CI 1.15 to 2.68) and income (eg, quintile (Q)1 vs Q5, men: aHR=2.07, 95% CI 1.35 to 3.17; women: aHR=1.84, 95% CI 0.91 to 3.71) were associated with increased rates of alcohol-attributable ED visits. Among men and women, superadditive joint effects (ie, greater than the sum of both exposures experienced independently) were observed between low SEP (education and income) and heavy episodic drinking and higher volume of alcohol use on alcohol-attributable ED visits. Our results indicate that individuals with lower SEP experience increased vulnerability to alcohol use and related harms. These findings highlight the urgent need for population-level interventions that reduce both the high burden and socioeconomic inequities in alcohol-attributable harm.

Same-day dischargeafter intracranial shunt revision: a retrospective propensity-matched safety analysis.

Patients are often observed overnight after ventricular shunt revision for hydrocephalus. We believe that a same-day discharge after a shunt revision is safe in the appropriate population. The purpose of this study was to determine the appropriate patient population and the safety profile for a same-day discharge following a ventricular shunt revision. We conducted a retrospective chart review of all shunt revisions at a single center from 2014 to 2021. We compared rates of emergency department visits, hospitalization, and revision at 30 and 90days between same-day discharge and control patients following shunt revision. Non-parametric, logistic regression, and chi-squared testing were performed to measure statistical significance with and without propensity score matching. A total of 996 patients were examined, with 56 (5.6%) patients being discharged on the same day as the surgery. Patients with a same-day discharge were older, more likely to have distal shunt failure, more likely to have undergone scheduled surgery, and less likely to have visited the emergency department in the prior 30days. Propensity score matching compared 29 revisions in each group; all covariates were non-significant (p > 0.05), and 30-day and 90-day outcomes were not significantly different the between same-day and non-same day discharge. These findings validate the safety profile for the same-day discharge in post-operative shunt patients and describe our patient cohort's preferred characteristics. Scheduled, distal shunt failure patients are preferred for early discharge post-operatively. When validated by further studies, this would provide improved patient comfort and decreased healthcare expenses for a shunt failure.

Acute coronary syndrome rates by age and sex before and during the COVID-19 pandemic in Israel: nationwide study.

There have been reports of sharp declines in acute coronary syndrome (ACS) during the COVID-19 pandemic. The study aims to assess nationwide ACS emergency department (ED) visit rates across age and sex subgroups and the general population, with a comparison before and throughout the pandemic's various phases. A multiple interrupted time series analysis was used to assess 61 349 ACS nationwide hospital visits from January 2018 to December 2021 at monthly intervals. The study period was divided into three periods: January 2018-February 2020 (pre-pandemic period); March 2020-January 2021 (early-pandemic period); February 2021-December 2021 (late-pandemic period). Segmented regression with a seasonally adjusted autoregressive moving average structure was used to build predictive models with an estimated reference trendline (counterfactual). Over 11 months of the early-pandemic period (lockdowns), the largest decrease in visits was seen in women aged 65 and above, of 18.4% [incidence rate ratio (IRR) 0.82; 95% confidence interval (CI) 0.77-0.86]. The lowest decrease was observed in men aged 25-64, of 7.2% (IRR 0.93; 0.91-0.94). During the late-pandemic period, which included high vaccination coverage and no lockdowns, the largest further decrease was in women aged 25-64 of 20.1% (IRR 0.80; 0.75-0.84) on average. The pandemic influenced ACS ED visits variably, with substantial declines during phases of high COVID-19 morbidity and mortality. Older individuals, particularly women, demonstrated the largest decrease in ACS ED visits, highlighting the need for tailored public health strategies to maintain public confidence in access to critical care during future health emergencies.

Use of emergency services in response to a flood: an account of the aftermath of the May 2023 flood in Romagna, Italy

BackgroundExtreme weather events due to human activities have significantly increased the frequency and severity of hydrological disasters like floods, impacting human health and healthcare systems worldwide. This study analyses the...