Patient Portal Messaging to Care Teams Is Substantial and Associated With Emergency Department Visits and Hospital Readmission Following Elective Orthopedic Surgery

Background: There has been an increase in patient use of electronic patient portal (EPP) messaging. Although it may improve communication, it can be time consuming, and its association with clinical outcomes and additional health care use is not well known in orthopedic surgery. Materials and Methods: Patients undergoing elective orthopedic procedures at an academic medical center between January 2016 and June 2023 were included. Chi-squared and t tests were used to compare characteristics between postoperative messengers and non-messengers for categorical and continuous variables, respectively. Two multivariable logistic regression analyses were conducted to assess factors associated with emergency department (ED) visits without readmission and any readmission. Results: Overall, 56,427 patients who underwent 64,709 surgeries were included; 580,531 messages were sent within 90 days of surgery. Postoperative EPP messaging was associated with increased odds of ED visits without re-admission (odds ratio [OR], 1.22; 95% CI, 1.13–1.31; P < .001). Black race (OR, 1.82; 95% CI, 1.59–2.10; P < .001), Medicaid insurance (OR, 2.21; 95% CI, 1.93–2.53; P < .001), hand procedures (OR, 2.84; 95% CI, 2.55–3.15; P < .001), and foot and ankle procedures (OR, 3.26; 95% CI, 2.52–4.22; P < .001) had the highest odds of ED visits without readmission. Postoperative EPP messaging was associated with increased odds of any readmission (OR, 1.50; 95% CI, 1.41–1.59; P < .001). Hand procedures (OR, 2.26; 95% CI, 2.06–2.47; P < .001) and Medicaid patients (OR, 1.42; 95% CI, 1.24–1.64; P < .001) had the highest odds of any readmission after sending a postoperative message. Conclusion: Postoperative EPP messages are frequently sent to orthopedic surgeons and their care teams. This research helps to identify those who may be at risk for increased health care use postoperatively. Optimizing postoperative EPP messaging engagement and care is critical to not only patients but health professional team well-being.