Returning to the emergency room: An analysis of emergency encounters following urologic outpatient surgery

Abstract

Introduction: Previous reports indicate urologic surgeries are associated with high rates of hospital re-admission. This study aims to identify factors associated with emergency room (ER) encounters following urologic outpatient surgery. Methods: All outpatient surgeries performed at The Ottawa Hospital between April 1, 2008, and March 31, 2018 by urology, general surgery, gynecology, and thoracic surgery were identified. All ER encounters within 90 days of surgery were captured. Rates of ER encounters by surgical service and procedure type were determined. Patient and surgical factors associated with ER encounters were identified. Factors included age, sex, marital status, presence of primary care provider, procedure, and American Society of Anesthesiologists (ASA) score. Results: A total of 38 377 outpatient surgeries by the included surgical services were performed during the study period, of which urology performed 16 552 (43.1%). Overall, 5641 (14.7%) ER encounters were identified within 90 days of surgery, including 2681 (47.5%) after urologic surgery. On multivariable analysis, higher ASA score IV vs. I was associated with higher risk of ER encounter (relative risk [RR] 1.95, 95% confidence interval (CI) 1.46–2.5) and being married was associated with a lower risk of ER encounter (RR 0.85, 95% CI 0.77–0.93). Urologic surgeries with the highest risk of ER encounters, compared to the lowest risk procedure (circumcision), were greenlight laser photo vaporization of the prostate (PVP) (RR 3.2, 95% CI 1.8–5.61), ureteroscopy (RR 3.2, 95% CI 1.9–5.4), and ureteric stent insertion (RR 3.1, 95% CI 1.8–5.5). Conclusions: ER encounters following outpatient surgery are common. This study identifies risk factors to recognize patients that may benefit from additional support to reduce ER care needs.