Rafael Alvarez, MD1, Alec N Khouri, BA1, Niki Matusko, MSc1, Aaron J Bonham, MSc1, Arthur M Carlin, MD2, Jonathan F Finks, MD1, Amir A Ghaferi, MD, MS1, Oliver A Varban, MD1. 1University of Michigan, 2Michigan Bariatric Surgery Collaborative
Background: Patients who present to the emergency department (ED) after bariatric surgery may incur significant costs with no additional benefit.
Objective: Our goal was to characterize patients who presented to the ED but may have been treated in an alternative setting.
Methods: We identified 131 patients who underwent primary bariatric surgery at a single-center academic institution between 2006-2016 who also presented to the ED within 30 days of surgery. Preventable ED visits were identified by excluding patients with life-threatening presentations and/or use of emergent ED-specific resources. Patients with preventable ED visits were matched 1:1 to controls (no ED visit) based on age, gender, body mass index, surgery date, surgeon, and procedure type. Perioperative and discharge characteristics were compared between groups. Analyses were performed using Chi-squared, t-test, and logistic regression.
Results: A total of 80 patients (61%) were identified as having a preventable ED visit after bariatric surgery. Mean time to ED visit was 13 days after surgery (+/-8 days). When compared to controls, patients with preventable ED visits had higher incidence of obstructive sleep apnea (63.75% vs. 47.44%; p = 0.0397), liver disease (22.50% vs. 10.26%; p=0.0386), and mobility limitations (5.00% vs. 0.00%; p=0.0462), and had more ED visits preoperatively (1.46 vs. 0.29; p=0.0001). These patients also had higher incidence of electrolyte abnormalities (67.50% vs. 39.74%; p=0.0005), reduced eGFR (5.00% vs. 0.00%; p=0.0462) and were more likely to be prescribed non-opioid analgesics (31.25% vs. 15.38%; p=0.0189), two or more antiemetics (5.00% vs. 0.00%; p=0.0462), or two or more anticoagulant/antiplatelet medications (7.50% vs. 0.00%; p=0.0140) at discharge after bariatric surgery. After multivariable logistic regression, independent risk factors associated with preventable ED visits included: anxiolytic prescription at discharge [OR 5.42 (1.58-18.58); p=0.007], electrolyte abnormalities [OR 4.31 (1.94-9.60); p<0.0001] and leukocytosis [OR 2.23 (1.01-4.93); p=0.048] at discharge, and the number of ED visits preoperatively [OR 2.03 (1.34-3.06); p=0.001]. There were no differences in operative time, hospital length of stay, provider performing discharge education, timing of first postoperative clinic visit, or standardized phone call. Severe complications, reoperation rates, and 1-year patient reported outcomes did not differ between patients with preventable ED visits and their matched cohort.
Conclusions: Preventable ED visits are common after bariatric surgery and are associated with risk factors that can be identified perioperatively. Identifying patients at risk for preventable ED visits and providing earlier follow up may decrease unnecessary ED visits after bariatric surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86657
Program Number: P599
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster