Thirty-Day Acute Healthcare Resource Utilization Following Outpatient Anterior Cruciate Ligament Surgery
Background: The need for hospital-based acute care following outpatient surgical procedures is expensive and measured as marker for quality. However, little information is available about events leading to emergency department (ED) visit or inpatient (IP) admission after ambulatory anterior cruciate ligament (ACL) surgery.
Methods: We studied adult patients who underwent outpatient ACL surgery in New York State between 2009 and 2013 using the Healthcare Cost and Utilization Project (HCUP) database. ED visits and IP admissions within 30 days of surgery were identified by cross-matching two additional independent HCUP databases.
Results: The final cohort included 26,873 subjects. We identified 1208 (3.90%, 95% CI: 3.6%-4.1%) secondary healthcare encounters of interest. The majority of these encounters were ED visits (951). The most common reasons were musculoskeletal pain (349, 28.9%), any infection (122, 10.1%), drug abuse (98, 8.1%), wound infection (87, 7.2%), deep venous thrombosis (77, 6.4%), and psychotic events (54, 4.5%). Patients operated in high volume surgical centers were less likely to require subsequent acute care (OR 0.47, p<0.001, 95% CI: 0.34 ~ 0.63), while Medicare/Medicaid patients carried higher odds (OR 2.52, 99% CI, 2.07-3.07).
Conclusions: The rate of hospital-based acute care following outpatient ACL surgery was 3.90%. Many of the events were expected complications related to surgery, such as infection and deep venous thrombosis. However, musculoskeletal pain, drug abuse, and psychotic events featured more prominently than expected. Our findings may direct efforts to address the reasons for seeking acute care after ACL surgery, reduce cost and improve quality of care.