• Adeline L Fecker, Maryam N Shahin, Spencer Smith, Jung U Yoo, Christina H Wright, Josiah N Orina, RyuWon Hyung AWHADepartment of Neurological Surgery, Oregon Health & Science University, Portland, OR., Clifford Lin, Jonathan A Kark, Travis C Philipp, and James M Wright.
• Department of Neurological Surgery, Oregon Health & Science University, Portland, OR.
• World Neurosurg. 2025 Jan 28: 123696123696.

BackgroundUtilization of the emergency department (ED) is associated with medical and social comorbidities. These factors may also be associated with medical complications after complex surgeries. This study investigated how pre-operative ED use increases risk of posterior lumbar interbody fusion (PLIF) complications.MethodsWe identified adult PLIF patients between 2016-2019 in the PearlDiver Claims Database. Clinical variables including Pre-operative ED use within 180 days were collected using International Classification of Disease (ICD-10) codes. Risk difference was calculated, and multivariable regression was performed.ResultsThis study included 13,010 (21.1%) patients who went to the ED before surgery and 48,065 (78.9%) who did not. Having a pre-operative ED visit significantly increased risk of a post-operative ED visit by 28.7 percentage points, 90-day readmission by 3.8 percentage points, and 30-day major-medical complications by 3.4 percentage points. Risk of these outcomes increased in a dose-dependent fashion. Compared to patients with zero pre-operative ED visits, patients who had six or more pre-operative ED visits had an 82.0 percentage point increase in risk for a post-operative ED visit, a 46.5 percentage point increase for six or more ED visits, a 6.1 percentage point increase for major medical complications, and 10.6% increase for readmission.ConclusionsPatients with any pre-operative ED visit had an increased risk for post-operative ED use, readmission, and medical complications. The risk difference increased with each additional pre-operative visit. Patient counseling and protocols that reduce preventable ED visit in the pre-operative period may reduce a patient's risk for costly post-operative complications.Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.

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