90-day Return to the Emergency Department Following Shoulder Arthroscopy: Prevalence, Risk Factors, and Reasons

Document Type : RESEARCH PAPER

Authors

1 Albert Einstein College of Medicine, Bronx, New York, USA

2 Montefiore Medical Center - Department of Orthopedic Surgery, Bronx, New York, USA

3 Albert Einstein College of Medicine, Department of Epidemiology & Population Health, Bronx, New York, USA

Abstract

Objectives: Return to the Emergency Department (ED) within 90-days following arthroscopic shoulder surgery 
represents a potential source of increased healthcare expenditures. Understanding the risk factors could bring about 
interventions aimed at reducing its prevalence. 
Methods: A retrospective review of all shoulder arthroscopies undertaken at a single academic institution from 
February 2016 through November 2023 was performed. Patient demographics and surgical data, including age, 
diagnosis of mental health disorder, history of prior ipsi- and/or contralateral shoulder arthroscopy, body mass index 
(BMI), smoking status, age-adjusted Charlson Comorbidity Index (ACCI), operative time and nature of the surgical 
procedure was collected. Patient visits to the ED within 12 months prior to surgery were recorded. Regression 
analysis was utilized to determine the independent predictors for 90-day postoperative ED return. 
Results: There were 584 total cases included in this study, of which 303 (52%) were women. The median age of 
the cohort was 57 years (IQR 51,62). There were 60 (10.3%) patients who experienced at least one unplanned 90-
day ED return visit. A diagnosis of mental health disorder (OR 2.67, 95% CI 1.50-4.75, P=0.001), an ED visit within 
3 months of surgery (OR 2.63, 95% CI 1.28-5.40, P=0.009), an ED visit between 3-6 months of surgery (OR 2.79, 
95% CI 1.41-5.54, P=0.003), and an ED visit between 6-12 months of surgery (OR 1.98, 95% CI 1.07-3.66, P=0.029) 
was significantly associated with a 90-day unplanned postoperative ED visit. Finally, having >3 preoperative ED 
visits was significantly associated with a 90-day postoperative ED visit (OR 9.41, 95% CI 3.68-24.06, P<0.001). 
Conclusion: Patients with a history of mental health disorder and those with a visit to the ED within 12 months prior 
to the planned shoulder arthroscopy should be counseled preoperatively regarding appropriate direct contact with 
the treating surgical team following discharge to minimize postoperative 90-day ED visits.
 Level of evidence: III

Keywords

Main Subjects

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The Archives of Bone and Joint Surgery
Volume 12, Issue 11
November 2024
Pages 760-769

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History

  • Receive Date: 29 February 2024
  • Revise Date: 10 August 2024
  • Accept Date: 05 August 2024

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