Emergency Department Utilization After Elective Hip Arthroscopy.

ABSTRACT

PURPOSE: (1) To identify the most common reasons for presentation to the emergency department (ED) after hip arthroscopy and (2) to determine preoperative risk factors for these ED visits. METHODS: Patients undergoing elective hip arthroscopy between the start of 2014 and the third quarter of 2015 were retrospectively evaluated using discharge records from New York and Florida. The primary outcome was all-cause 7-, 30-, and 90-day ED utilization. Reasons for presentation to the ED were recorded and manually stratified. Bivariate and multivariate analyses were performed to identify independent predictors of ED utilization. RESULTS: The overall rate of postoperative ED visits after hip arthroscopy was 1.8% at 7 days, 3.5% at 30 days, and 6.6% at 90 days. Postoperative pain was the most common reason for visiting the ED at all time points (25.4%, 23.7%, and 20.3%, respectively), followed by gastrointestinal complaints (19.5%, 15.0%, and 15.3%, respectively) and neurologic complaints (8.7%, 9.8%, and 10.5%, respectively). Female sex (relative risk [RR], 1.86; 95% confidence interval [CI], 1.35-2.54; P < .001), Medicare insurance (RR, 2.39; 95% CI, 1.41-4.04; P < .001), and Medicaid insurance (RR, 3.45; 95% CI, 2.37-5.04; P < .001) were identified as independent risk factors for ED utilization at 90 days postoperatively. Of all patients who presented to the ED, only 3.9% were admitted to the hospital. CONCLUSIONS: ED visits after elective hip arthroscopy are uncommon. The most common reason for a visit is postoperative pain, followed by gastrointestinal and neurologic complaints. After accounting for confounding, we found that female sex, Medicare and Medicaid insurance status, and hypertension were risk factors for all-cause ED visits at up to 90 days postoperatively. Only 4% of patients who present to the ED require inpatient hospital admission. LEVEL OF EVIDENCE Level IV, retrospective cohort study.