• Meghan V Flood, Neil A Manson, Alana J Green, Edward P Abraham, and Erin Bigney.
• Saint John Regional Hospital, Saint John, New Brunswick, Canada.
• Global Spine J. 2018 Aug 1; 8 (5): 440-445.

Study DesignRetrospective study.ObjectiveTo identify prevalence of, reasons for, and predictors of emergency department (ED) utilization 6 months following elective thoracolumbar spine surgery.MethodsA retrospective review of a patient database was conducted (N = 577). Visits were divided by orthopedic spinal surgeons into (1) avoidable ED visit, (2) appropriate/no visit, and (3) unrelated visit.MeasuresDemographics, pain scores, patient characteristics, and surgical factors.ResultsA total of 14.38% of patients made an ED visit the majority for avoidable reasons (11.43%). Avoidable ED visits were predominately attributed to pain (45.5%) and physiology-related issues (50.0%). Significant differences in the Numerical Rating Scale-leg pain (NRS-L); U = 13 931, P = .031) were found. Patients with avoidable visits had higher leg pain prior to surgery than those without an avoidable visit. Marital status was also statistically significant, χ2(2, N = 535) = 8.189, P = .017. Patients were more likely to make an avoidable postoperative ED visit if they were either single or divorced/separated compared to patients who were married. A multivariate logistic regression model including NRS-L and marital status was statistically significant, χ2(3) = 10.14, P = .017; however only explained 3.7% of the variance.ConclusionA large percentage of elective thoracolumbar surgery patients returned to the ED within 6 months for avoidable reasons. Patients likely to make avoidable visits could not be identified prior to surgery in a clinically meaningful way. Reasons for patients returning to the ED for avoidable reasons focused on pain management and minor physiological symptoms. Enhanced presurgical education may manage postsurgical expectations helping to prevent avoidable ED visits.

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