Emergency Department Use Within 90 Days After Single-Level Posterior Cervical Foraminotomy.

Abstract

Background: This study sought to characterize the incidence of, timing of, predictive factors for, and reasons for emergency department (ED) visits within 90 days of single-level posterior cervical foraminotomy (PCF). These visits, after PCF, have received limited attention.

Materials and methods: The 2010-2022 M161 PearlDiver database was queried for elective single-level PCFs, excluding multilevel procedures, midline laminectomies, fusions, or other posterior/anterior procedures, as well as indications of trauma, infection, or neoplasm. Patient age, sex, Elixhauser Comorbidity Index (ECI), insurance, and region were extracted. Weekly ED use after PCF was calculated. Multivariate analyses were used to identify predictive factors for ED use, and primary ED diagnoses were categorized.

Results: Of 10,588 PCF patients, 9.09% (n=962) visited the ED within 90 days after surgery, mostly in the first 4 weeks. Multivariate analysis identified that predictors included younger age (odds ratio [OR], 1.02 per decade decrease), female sex (OR, 1.19), higher ECI (OR, 1.28 for ECI 1-2; OR, 1.41 for ECI 3-4; OR, 1.51 for ECI ≥5), Midwest (OR, 1.16) or Northeast (OR, 1.19) region, and Medicare (OR, 1.09) or Medicaid (OR, 1.57) coverage. In the first 4 weeks, 69.9% of ED visits were related to the surgical site; this decreased to 27.1% thereafter.

Conclusion: Almost one-tenth of PCF patients visited the ED within 90 days after surgery. Specific patient characteristics were associated with ED visits, with surgical site-related diagnoses predominating in the acute postoperative period. Tailoring health care interventions based on timing of, risk factors for, and causes of ED visits may enhance outcomes and reduce costs. [Orthopedics. 2025;48(1):51-56.].