Arthroscopic Bankart Repair Is Associated With Lower 90-Day Emergency Department Use Than Open Repair, With Smoking, Medicaid Insurance, and Depression as Additional Independent Predictors.

PURPOSE: To characterize the timing, frequency, and predictors of 90-day emergency department (ED) visits after Bankart repair using a national administrative database.

METHODS

Patients undergoing primary arthroscopic or open Bankart repair were identified from the 2010 to 2023 Q1 PearlDiver M170 database. Patients with infection or neoplasm within 90 days preoperatively or less than 90 days of database follow-up were excluded. Multivariable logistic regression identified independent predictors of ED visits within 90 days postoperatively. Among ED users, weekly visit timing was compared with a baseline rate (range of rates from postoperative weeks 53-57), and primary diagnoses at 1, 2, and 3 months were categorized.

RESULTS

Of 149,024 patients (age 33.4 years, 66.1% men, 95.5% arthroscopic), 11,760 (7.9%) visited the ED, with 25.8% of visits occurring during the first 2 postoperative weeks. Independent predictors of ED use included (in decreasing odds ratio order) recent smoking (odds ratio 2.99), Medicaid insurance (2.03), depression (1.70), prior opioid use (1.56), social determinants of health (1.55), diabetes (1.45), Medicare insurance (1.36), open surgical approach (1.34), female sex (1.33), body mass index  ≥ 30 (1.24), Midwest region (1.21), and age (1.01. per year decrease) (P < .001 for all). Shoulder-related visits accounted for 33.2% of ED encounters in month 1, declining to 17.6% and 13.0% by months 2 and 3, with shoulder pain as the leading subcategory at every postoperative month.

CONCLUSIONS

After Bankart repair, nearly 8% of patients presented to the ED within 90 days, with the highest incidence occurring during the first 2 postoperative weeks. The strongest independent predictors of ED visits included smoking (odds ratio 2.99), Medicaid insurance (2.03), depression (1.70), prior opioid use within 6 months (1.56), social determinants of health (1.55), diabetes (1.45), Medicare insurance (1.36), open surgical approach (1.34), and female sex (1.33). Shoulder pain was the most common shoulder-related reason for ED presentation across all 3 postoperative months.

LEVEL OF EVIDENCE: Level III, retrospective comparative study.