Margaret E Smith, MD, Aaron Bonham, MSc, Amir Ghaferi, MD, MS. University of Michigan
INTRODUCTION: Postoperative readmissions following bariatric surgery have declined over recent years; however, a concurrent reduction in postoperative emergency department (ED) visits has not occurred. The most common reasons for ED encounters include abdominal pain, dehydration and nausea. A large proportion of these visits may be appropriately addressed in lower acuity centers (urgent care center, infusion center, etc). Given the substantial cost associated with unnecessary utilization of healthcare resources, we sought to determine the economic impact of shifting potentially avoidable ED visits to lower acuity centers.
METHODS AND PROCEDURES: Using data from a large statewide quality improvement collaborative, we identified patients undergoing primary, non-revisional bariatric surgery from January 2012 – June 2015 (n=20,057). Information regarding 30-day postoperative ED use, chief complaint at presentation, and 30-day readmission was obtained. “Potentially avoidable ED visits” were defined as 30-day postoperative ED visits not resulting in an admission. To assess the economic impact, we evaluated price-standardized payments for ED visits which were available in a subset of our population (n=5,499). Average Urgent Care Center episode cost was then calculated from a private insurer’s claims data for all post-bariatric surgery Urgent Care visits in 2015.
RESULTS: In our full cohort of 20,057 patients, the 30-day postoperative ED visit rate was 8.2% (n=1,638). The 30-day readmission rate was 4.1% (n=812). The average ED episode cost in patients who were not readmitted (i.e., “potentially avoidable ED visits”) was $1,310. The average cost of an Urgent Care Center visit was $126. Triaging a potentially avoidable ED visit to an Urgent Care Center would generate a savings of $1,184 per patient. In just the subset of 2014 patients with claims data, shifting the potentially avoidable ED visits to an Urgent Care setting would result in a net savings of $178,363, with much higher potential savings ($977,984) when extrapolated to the entire cohort. (Figure)
CONCLUSION(S): In a large statewide collaborative, as many as 50% of 30-day postoperative ED visits after bariatric surgery are potentially avoidable. If all of these visits were shifted to lower cost settings, it would result in an annual savings of $279,424 in this single state cohort. If extrapolated to the entire United States the net savings would be $7.4 million per year. Triaging of patients to lower acuity centers may serve as a template for decreasing excessive ED utilization and thus containing costs among post-operative bariatric patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88121
Program Number: S010
Presentation Session: Outcomes/Quality Session
Presentation Type: Podium