Associated factors and costs of avoidable visits to the emergency department among cancer patients: 1-year experience in a tertiary care hospital in South Korea

Abstract

Purpose Patients receiving palliative care make avoidable emergency department visits (AvED), which may increase economic and social costs. However, the proportion of AvED among all patients, including cancer patients after curation, and the resulting costs are unknown in Asia. This study aimed to investigate the proportion, characteristics, and costs regarding factors associated with AvED among cancer patients. Methods This retrospective cohort study analyzed the medical records of patients who visited the emergency department (ED) at a tertiary care hospital in Korea in 2016. Data regarding patients' demographic, cancer-related, and clinical characteristics were collected. Results ED visits by a total of 4346 patients were included in the analysis, of which 2420 visits (55.7%) were avoidable. In the multivariate logistic model, the following main factors were associated with AvED: stay in ED (odds ratio [OR] 0.998, 95% confidence interval [CI] 0.997-0.999, P < 0.001), distance to the home from the ED (OR 0.998, 95% CI 0.997-0.999, P < 0.001), multiple ED visits in 1 year (OR 1.204, 95% CI 1.156-1.255, P < 0.001), primary progression (vs. after curation) (OR 0.748, 95% CI 0.627-0.892, P = 0.001), and chief complaint being a gastrointestinal symptom (vs. pain) (OR 1.871, 95% CI 1.188-2.946, P = 0.007). The average cost per visit in the AvED group was $369.80, and the annual total cost for all AvEDs was $894,877. Conclusions Our study showed that 55.7% of all ED visits by cancer patients visiting the ED of a tertiary care hospital were avoidable, and several factors were associated with AvED.