Emergency Department Utilization Among Skin Cancer Patients: A Retrospective Study of the National Emergency Department Sample 2013-2015

Abstract Background: Skin cancer-related emergency department (ED) visits are among the most common cancer-related ED visits in the United States. However, ED utilization among skin cancer patients has not been evaluated. Objective: To assess overall utilization of EDs among skin cancer patients, reasons for skin cancer-related visits, and factors associated with inpatient admission. Methods: This was a retrospective, cross-sectional study of adults with skin cancer presenting to EDs using years 2013-2015 of the Nationwide Emergency Department Sample. Results: 693,835 of the 223,329,909 weighted ED visits were made by patients with skin cancer. Visits among this population were frequently due to age-related comorbidities and skin cancer treatment-specific adverse events. Melanoma accounted for the minority of skin cancer-related visits (27.58%) but over half of subsequent inpatient admissions (51.18%) and was associated with greater odds of inpatient admission compared to keratinocyte carcinoma (OR 1.278, 95% CI 1.264-1.293). Limitations: Treatment and staging codes were not available, thus differences in ED utilization among skin cancer stages and treatment approaches could not be assessed. Conclusion: Ultimately, these findings are important in improving anticipatory outpatient care for patients with skin cancer and in guiding appropriate management of this unique population in the ED.