Post-appendectomy visits to the emergency department within the global period: A target for cost containment

Background: Postoperative visits to the emergency department (ED) instead of the surgeon's office consume enormous cost. Hypothesis: Postoperative ED visits can be avoided. Setting: Fully accredited, single-institution, 617-bed hospital affiliated with the University of Connecticut School of Medicine. Patients: Retrospective analysis of 597 consecutive patients with appendectomies over a 4-year period. Methods: Demographic and medical data, at initial presentation, surgery, and ED visit were recorded as categorical variables and statistically analyzed (Pearson χ² test, Fisher exact test, and linear-by-linear). Costs were calculated from the hospital's billing department. Results: Forty-six patients returned to the ED within the global period with pain (n = 22, 48%), wound-related issues (n = 6, 13%), weakness (n = 4, 9%), fever (13%), and nausea and vomiting (n = 3, 6%). Thirteen patients (28%) required readmission. Predictive factors for ED visit postoperatively were perforated appendicitis (2-fold increase over uncomplicated appendicitis) and comorbidities (cardiovascular or diabetes). The cost of investigations during ED visits was $55,000 plus physician services. Conclusions: ED visits during the postoperative global period are avoidable by identifying patients who may need additional care; improving patient education, optimizing pain control, and improving patient office access.