Predictors of Emergency Visits Within 14 Days of Outpatient Endoscopy at A Safety-Net Hospital: A Case-Control Study

Abstract

AIMS: Gastrointestinal endoscopic procedures are commonly performed outpatient procedures associated with adverse events that may lead to emergency department visits. Establishing risk factor for post-endoscopy emergency department visits may guide quality improvement efforts. MATERIALS AND METHODS: Matched case control study of patients over the age of 18 presenting to the emergency department of a safety-net hospital within two weeks of any outpatient endoscopic procedure between July 1, 2013 and December 31, 2014. Controls were matched to cases by age, sex, procedure type, date, and day of week procedure was performed. Univariable and multivariable analysis were performed to identify predictors of emergency visits after endoscopy. REULTS: We identified 143 cases from a total of 6,601 outpatient procedures during the study period. 64 (44.8%) of the visits were attributed to the procedure yielding a visit rate of 0.97%. Compared to controls, cases were more likely to have MediCal (Medicaid) insurance (75.7% vs 59.2%, p = 0.003), prior ED visits (2.5 vs 0.5, p < 0.001), multiple primary care visits (4.9 vs 3.3, p < 0.001), trainee involvement (62.9% vs 44.4%, p = 0.002), and speak English (67.1% vs 54.9%, p = 0.04). On multivariable analysis of cases with visits attributable to the procedure, antiplatelet/anticoagulant use (OR 2.81, CI 1.07-7.34, p = 0.04), MediCal insurance (OR 2.55, CI 1.02-6.40, p = 0.05), multiple ED visits per year (OR 3.31, CI 2.22-4.94, p < 0.001), number of endoscopic interventions (OR 1.22, CI 1.06-1.40, p = 0.006), and trainee involvement (OR 2.55, CI 1.09-5.97, p = 0.03) were all risk factors for post-procedure visits. CONCLUSION: In a safety-net system, medically complex patients, greater number of endoscopic interventions, and lower socioeconomic status may influence emergency department utilization after endoscopy. This information may inform future quality improvement efforts.