PMID- 35325679
OWN - NLM
STAT- MEDLINE
DCOM- 20220525
LR  - 20220530
IS  - 1095-8673 (Electronic)
IS  - 0022-4804 (Linking)
VI  - 276
DP  - 2022 Aug
TI  - Characterizing 30-Day Postoperative Acute Care Visits: A National Surgical 
      Quality Improvement Program Collaborative Analysis.
PG  - 1-9
LID - S0022-4804(22)00071-3 [pii]
LID - 10.1016/j.jss.2022.01.031 [doi]
AB  - INTRODUCTION: Many postoperative acute care visits (PACVs) are likely more 
      appropriately addressed in lower acuity settings; however, the frequency and 
      nature of PACVs are not currently tracked by the National Surgical Quality 
      Improvement Program (NSQIP), and the overall burden to emergency departments and 
      urgent care centers is unknown. METHODS: NSQIP collaborative data were augmented 
      to prospectively capture 30-d PACVs for 1 y starting October 2018 across all 
      NSQIP specialties, including visit reason and disposition. Data were analyzed 
      using binomial logistic regression. RESULTS: A total of 9933 patients were 
      identified; 12.0% (n = 1193) presented to an acute care setting over 1413 visits, 
      most commonly for surgical pain (15.4%) in the absence of an identified 
      complication. Visits most commonly resulted in discharge (n = 817, 68.5%) or 
      admission (n = 343, 24.3%). Variables independently associated with visits 
      resulting in discharge included age (odds ratio [OR] 0.99 per year, P < 0.001), 
      increasing comorbidities (1-2 [OR 1.55, P < 0.001]; 3-4 [OR 2.51, P < 0.001]; 5+ 
      [OR 2.79 P < 0.001]), operative duration (OR 1.08 per hour, P = 0.001), and 
      nonelective (OR 1.20, P = 0.01) or urologic (OR 1.46, P = 0.01) procedures. 
      CONCLUSIONS: PACVs are an overlooked burden on emergency medicine providers and 
      healthcare systems; most do not require admission and could be potentially 
      triaged outside of the acute care setting with improved perioperative care 
      infrastructure. Younger patients, those with multiple comorbidities, and those 
      undergoing nonelective procedures deserve special attention when designing 
      initiatives to address postoperative acute care utilization. Data regarding PACVs 
      can be routinely collected with minor modifications to current NSQIP workflows.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Sweet, Ashley L
AU  - Sweet AL
AD  - Department of Surgery, Oregon Health & Science University, Portland, Oregon.
FAU - Sutton, Thomas L
AU  - Sutton TL
AD  - Department of Surgery, Oregon Health & Science University, Portland, Oregon.
FAU - Curtis, Krista A
AU  - Curtis KA
AD  - Legacy Emanuel Medical Center, Oregon Health & Science University Health Systems, 
      Portland, Oregon.
FAU - Knapp, Nathan
AU  - Knapp N
AD  - Department of Surgery, Oregon Health & Science University, Portland, Oregon.
FAU - Sheppard, Brett C
AU  - Sheppard BC
AD  - Department of Surgery, Oregon Health & Science University, Portland, Oregon.
FAU - Zink, Karen A
AU  - Zink KA
AD  - Department of Surgery, Providence Portland Medical Center, Portland, Oregon. 
      Electronic address: kzink@orclinic.com.
LA  - eng
PT  - Journal Article
DEP - 20220321
PL  - United States
TA  - J Surg Res
JT  - The Journal of surgical research
JID - 0376340
SB  - IM
MH  - *Ambulatory Care Facilities/statistics & numerical data
MH  - Data Analysis
MH  - *Emergency Service, Hospital/statistics & numerical data
MH  - *Facilities and Services Utilization/statistics & numerical data
MH  - Humans
MH  - *Postoperative Complications/therapy
MH  - Quality Improvement
OTO - NOTNLM
OT  - Acute care visits
OT  - National Surgical Quality Improvement Program
OT  - Quality improvement
OT  - Surgical outcomes
EDAT- 2022/03/25 06:00
MHDA- 2022/05/26 06:00
CRDT- 2022/03/24 20:11
PHST- 2021/09/15 00:00 [received]
PHST- 2021/11/15 00:00 [revised]
PHST- 2022/01/24 00:00 [accepted]
PHST- 2022/03/25 06:00 [pubmed]
PHST- 2022/05/26 06:00 [medline]
PHST- 2022/03/24 20:11 [entrez]
AID - S0022-4804(22)00071-3 [pii]
AID - 10.1016/j.jss.2022.01.031 [doi]
PST - ppublish
SO  - J Surg Res. 2022 Aug;276:1-9. doi: 10.1016/j.jss.2022.01.031. Epub 2022 Mar 21.