EP658 - Predicting Return To Emergency Department After Colon Resection

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Purpose/Background: Emergency departments (ED) across the country are experiencing surges in the numbers of patients seeking medical attention. Persons undergoing colon resection are at risk of developing complications following discharge from their index hospital admission. In the setting of ever strained resources, it is becoming increasingly important to identify factors that influence representation to the ED.

Methods/Interventions: Patients discharged following colon resection at two tertiary care hospitals in Nova Scotia between April 1st 2021 – March 31st 2023 were identified by means of Canadian Classification of Health Interventions (CCI) codes in administrative data sets. Demographic data such as sex, age, geographic location, comorbidity score, access to primary care, surgical approach (open vs. laparoscopic), and indication (benign vs. malignant) were collected for all patients. Those patients representing to any provincial ED within 90 days of surgery were further characterized by ED visit type (surgical vs. medical), time to presentation, and reason for presentation using a retrospective chart review.

Results/Outcomes: A total of 489 patients underwent colon resection between April 1st 2021 and March 31st 2023, of which 160 (32.7%) represented to the ED within 90 days. Patients who represented had a mean age of 63.8 years, were 51.9% female and had a mean Charlson Comorbidity Score of 2.4. Similarly, the majority (89.4%) had access to primary care, were living in an urban location (82.5%) at time of surgery, and had surgery for a malignant indication (50.0%), with no significant differences compared to those who did not represent. In contrast, those who represented did have a higher proportion of cases done using open surgical technique (110/160, 68.8%) compared to those who did not represent (179/319, 56.1%) (p=0.008). Among patients who represented for a surgical reason (121/160, 75.6%), the visit to the ED typically occurred at a median of 8 (IQR 3-27) days from discharge and resulted in hospital readmission in only 32/121 (26.4%) cases. Among patients who represented for a medical reason (39/160, 24.4%), the visit typically occurred at a median of 24 (IQR 14-60) days from discharge, resulting in hospital readmission in 13/39 (33.3%) cases. The most common reasons for representation were identified as being all-cause surgical site infection in 33 (20.6%) patients, post-operative hardware/dressing complication in 18 (11.3%) patients, and stoma related complications in 14 (8.8%) patients. Interestingly, uncomplicated surgical pain was only cited in 8 (5%) of those returning to the ED.

Conclusion/Discussion: A substantial proportion of patients undergoing colon resection find themselves presenting to the ED in Nova Scotia following discharge. The majority avoid readmission. Common surgical reasons for return to the ED included all-cause surgical site infection, post-operative hardware/dressing and stoma related complications, all of which represent actionable items that could be addressed through closer surgical follow-up or in a primary care setting.