• Jeffrey M Hills, Inamullah Khan, Ahilan Sivaganesan, Benjamin Weisenthal, Joshua Daryoush, Marjorie Butler, Mohamad Bydon, Kristin R Archer, Anthony Asher, and Clinton J Devin.
• Department of Orthopaedics and Reha-bilitation, Vanderbilt University Medical Center, Nashville, Tennessee.
• Neurosurgery. 2019 Aug 1; 85 (2): E258-E265.

BackgroundEmergency department (ED) overuse is a costly and often neglected source of postdischarge resource utilization after spine surgery. Failing to investigate drivers of ED visits represents a missed opportunity to improve the value of care in spine patients.ObjectiveTo identify the prevalence, drivers, and timing of ED visits following elective spine surgery.MethodsPatients undergoing elective spine surgery for degenerative disease at a major medical center were enrolled in a prospective longitudinal registry. Patient and surgery characteristics, and patient-reported outcomes were recorded at baseline and 3 mo after surgery, along with self-reported 90-d ED visits. A multivariable regression model was used to identify independent factors associated with 90-d ED visits. For a sample of patients presenting to our institution's ED, charts were reviewed to identify the reason and time to ED postdischarge.ResultsOf 2762 patients, we found a 90-d ED visit rate of 9.4%. One-third of patients presented to our institution's ED and of these, 70% presented due to pain or medical concerns at 9 and 7 d postdischarge, respectively, with 60% presenting outside normal clinic hours. Independent risk factors for 90-d ED visits included younger age, preoperative opioid use, chronic obstructive pulmonary disorder, and more vertebral levels involved.ConclusionNearly 10% of elective spine patients had 90-d ED visits not requiring readmission. Pain and medical concerns accounted for 70% of visits at our center, occurring within 10 d of discharge. This study provides the clinical details and a timeline necessary to guide individualized interventions to prevent unnecessary, costly ED visits after spine surgery.Copyright © 2018 by the Congress of Neurological Surgeons.

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