Investigating factors associated with postmastectomy emergency department visits: A population-based analysis.
Bibliographic record
Abstract
241 Background: In 2016, a multi-pronged pathway was implemented in 13 hospitals across the province of Alberta, Canada to improve the mastectomy perioperative care experience focused on two objectives: 1) to increase same day surgery mastectomy rates and 2) decrease the number of unnecessary postoperative ED visits. The pathway successfully increased same day mastectomy rates from 1.7% to 47.8%, however the rate of postoperative ED visits remained high at 22-27%, a rate several-fold greater than described at other centers (3.1-12.8%) in spite of focused interventions at the patient and provider level to enhance perioperative support. Objective: To investigate potential factors associated with high postoperative ED visits following mastectomies in Alberta, Canada. Methods: Data was collected using the Discharge Abstract Database, and the National Ambulatory Care Reporting System database. Eligible patients included all women over 18 years old who underwent a mastectomy in the province of Alberta between 2004 and 2018. Patient demographics and operative variables including age, SES, Charlson comorbidities, date of surgery, surgery type (same-day vs. overnight) and health regions were collected. Primary outcome of interest was an ED visit within 30 days of mastectomy. Univariate and multivariate analyses were performed to identify independent predictors for post-operative ED visits. Results: A total of 18,076 patients had mastectomy during the study period, of which 4219 (23.3%) had an ED visit within 30 days of surgery. The most common causes of ED visits were infection, pain, and nausea/vomiting. Independent factors associated with ED visits were increasing age, overnight stay mastectomy, having reconstruction, cerebrovascular disease, chronic pulmonary disease, peptic ulcer disease, diabetes, depression, and living rurally. There was a slight decrease in ED visits post-implementation of the perioperative pathway (21.6% vs. 23.7%) but it was not statistically significant in the multivariable analysis. Conclusions: Post-operative ED visits remain high despite initiating a province-wide surgical pathway in 2016 which emphasizes patient education and improved perioperative care and supports. ED visits are associated with geographic location, specific comorbidities, and overnight stays. Currently, the majority of ED visits are manageable in non-emergent settings. Further investigations are necessary to discern whether additional perioperative interventions can curb the high ED visit rate.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".