Unplanned emergency department or urgent care visits after outpatient rotator cuff repair: potential for avoidance
These authors queried the records for 1306 outpatient rotator cuff repairs (RCR) in a closed health care system and all unplanned emergency department and urgent care visits within 7 days of procedures. The results for RCR were compared with other typical outpatient orthopedic procedures (knee arthroscopy, carpal tunnel release, and anterior cruciate ligament reconstruction).
These authors queried the records for 1306 outpatient rotator cuff repairs (RCR) in a closed health care system and all unplanned emergency department and urgent care visits within 7 days of procedures. The results for RCR were compared with other typical outpatient orthopedic procedures (knee arthroscopy, carpal tunnel release, and anterior cruciate ligament reconstruction).
Avoidable diagnoses (ADs) for the unplanned visits were defined in advance as visits for (1) constipation, (2) nausea or vomiting, (3) pain, and (4) urinary retention.
90 patients had unplanned return visits (6.9%), with 34 for avoidable diagnoses (2.6%). Pain was the most common avoidable diagnosis. However, when RCR was compared with other case types, unplanned visits for urinary retention were significantly more common.
The 1306 RCRs led to a greater proportion of unplanned visits than the combined 5825 other types of procedures studied.
In an attempt to decrease the number of ADs, this medical system has begun to implement a comprehensive perioperative care package including
In an attempt to decrease the number of ADs, this medical system has begun to implement a comprehensive perioperative care package including
(1) counseling on pain management, constipation prevention, and return precautions
(2) prescriptions for postoperative pain to be filled the day before surgery
(3) a single 375-mL glass of a high-carbohydrate clear liquid up to 2 hours before surgery
(4) multimodal analgesia with acetaminophen, gabapentin, and a nonsteroidal antiinflammatory drug started preoperatively
(5) fluid restriction to less than 500 mL during surgery
The effectiveness of these steps in reducing unplanned return visits is yet to be determined.
Comment: The quality of the outpatient surgery patient experience requires careful patient selection, detailed preoperative education and planning, and a readily available system for responding to patient concerns and medical issues such as those identified here.
Comment: The quality of the outpatient surgery patient experience requires careful patient selection, detailed preoperative education and planning, and a readily available system for responding to patient concerns and medical issues such as those identified here.
The reasons for the relative increase in urinary retention for patients having RCR in comparison to other procedures may be related to an increased use of pain medication by these patients or because RCR patients may be older and male (with risk of prostate issues). Extra preoperative attention may be necessary to avoid unplanned visits for this population.
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