Unplanned Emergency Department Visits within 30-Days of Mastectomy and Breast Reconstruction

Background: Unplanned emergency department (ED) visits are often overlooked as an indicator of care quality. Our objectives were to (1) determine the rate of 30-day ED visits following mastectomy with or without immediate reconstruction, (2) perform a risk analysis of potential factors associated with ED return, and (3) assess for potentially preventable visits with a focus on returns for pain. Methods: Using the Healthcare Cost and Utilization Project data, we identified adult women who underwent mastectomy with or without reconstruction. Multivariable logistic regression was performed to evaluate risk of unplanned ED visits. We identified and sorted diagnostic codes to investigate why patients were seeking ED care. Additionally, we performed a subgroup analysis on patients returning with a pain-related diagnosis to evaluate risk. Results: Of 159,275 cases of mastectomy with or without immediate reconstruction, 4,917 (3.1%) experienced an unplanned return to the ED within 30 days of operation. Being younger, having any payer type other than a private payer, or having any number of comorbid conditions resulted in increased odds of revisit to ED. A substantial proportion of those who returned (23%) presented with a pain-related diagnosis. Only 0.9% of cases with a 30-day ED return were readmitted. Conclusions: Numerous patients return to the ED within 30-days of mastectomy with or without immediate reconstruction. There is a need for policy makers and physicians to implement strategies to reduce discretionary ED utilization, specifically among younger or publically insured patients. Combining unplanned ED visits with readmission rates as a care quality indicator warrants consideration. Funding: The work was supported by a Midcareer Investigator Award in Patient-Oriented Research (2 K24-AR053120-06) to Kevin C. Chung. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional funding for this work was supported by awards from the Chang Gung Memorial Hospital (project CORPG3G0111 and CORPG3G0161) to Ting-Ting Chung. Corresponding author: Kevin C. Chung, MD, MS, Section of Plastic Surgery, The University of Michigan Health System, 1500 E. Medical Center Drive , 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-5340, Phone: 734-936-5885, Fax: 734-763-5354, E-mail: kecchung@med.umich.edu ©2018American Society of Plastic Surgeons