Predictors of Unplanned Postoperative Visits in a Veterans Affairs Hand Surgery Practice.

BACKGROUND

After elective soft tissue hand surgery, patients may make unplanned appointments when experiencing pain or anxiety. These appointments can contribute to late arrivals and delays in other clinics. Identifying predictive factors of unplanned postoperative visits may improve perioperative risk management or education and reduce unplanned appointments.

METHODS

Elective soft tissue hand surgeries performed from July 1, 2018, to June 30, 2022 (excluding 2020, the COVID-19 pandemic year) in Veterans Affairs North Florida/South Georgia Veterans Health System operating rooms by the plastic surgery service were identified in the electronic health record. Data collected included age, sex, current smoking status, and residential zip code, as well as diagnoses of diabetes, depression, anxiety, or posttraumatic stress disorder (PTSD). Postoperative clinic notes were examined for 3 months for each patient. A χ2 analysis with P < .05 was used to determine whether age > 60 years, sex, proximity to the Malcom Randall Veterans Affairs Medical Center (MRVAMC), clinic, diabetes, smoking, depression, anxiety, or PTSD were statistically significant independent risk factors for unplanned appointments.

RESULTS

Of 1009 hand surgeries, 81 (8.0%) patients returned for unplanned visits. Age (P = .82), proximity to MRVAMC (P = .34), diabetes (P = .60), current smoking (P = .55), anxiety (P = .33), and PTSD (P = .37) were not statistically significant predictors of unplanned visits. Depression (P = .04) and female sex (P = .03) were found to be independent risk factors for unplanned appointments. The most common indication for the appointment was pain.

CONCLUSIONS

Female sex and a depression diagnosis were statistically significant predictors for unplanned appointments in the early postoperative period after elective soft tissue hand surgery.