Unscheduled Clinical Encounters in the Postoperative Period After Adult and Pediatric Urologic Surgery.

Objective: To qualify and quantify unscheduled clinical encounters (UCEs) in postoperative urologic patients and to identify patient and procedural risk factors for UCEs.

Materials And Methods: All UCEs, including phone calls, emails, patient portal messages, clinic visits, ER visits, and hospital readmissions, were analyzed, including the reason for the interaction (eg, pain, infection, etc) were assessed retrospectively for consecutive surgical patients over a 3-month period. Demographic and perioperative data for each patient and surgery was recorded and risk factors for UCE were determined using uni- and multivariate analyses.

Results: Approximately 40% of adult and pediatric patients experienced a UCE, the most common being phone calls (adult-68.2%, pediatric-90.0%) for new medical concerns (adult-67.7%, pediatric-58.1%). Risk factors for UCE in the adult population included lower BMI, living closer to the surgical hospital, discharge with catheter/wound packing, higher discharge pain, and open (vs endoscopic) surgery. In the pediatric population, surgery on the urethra/ureter and discharge with catheters predicted for UCE. UCEs led to changes in clinical management (17%, 21%), unplanned clinic visits (12%, 20%), and hospital readmissions (6%, 3%) for both adult and pediatric patients, respectively.

Conclusion: Nearly 40% of both adult and pediatric patients experienced an unplanned need for the healthcare system in the postoperative period. The effect that UCEs have on overall costs and patient satisfaction, as well as ways to decrease UCEs, require further study.