Noah J Switzer1, Jerry Dang2, Samantha Warwar1, Sabrena Noria1. 1The Ohio State University, 2University of Alberta
INTRODUCTION: Given almost half the readmissions following bariatric surgery are considered preventable, with the number one reason being nausea, vomiting and dehydration (NVD), the purpose of this study was to identify factors that led patients to seek care for NVD in an outpatient versus hospital based setting. The complexities of both bariatric patients, and the procedures themselves, lead to high rates of readmission. Therefore identifying risk factors for re-admission and recognizing factors that limit a patient’s access outpatient care may help alleviate the healthcare burden and improve patient outcomes.
METHODS AND PROCEDURES: After IRB exemption, a retrospective review was conducted of prospectively collected data from The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for the year 2016. Patients >18 years old who underwent Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (LSG), or revisional surgery were included. The outcome of interest was re-presentation for NVD at either an outpatient clinic (OPC), an emergency department without subsequent hospital admission (ED), or to the emergency room resulting in hospital readmission (ED-H). Univariate regression analysis was performed and variables with significance <0.1 were analyzed in the multivariate regression model.
RESULTS: Subjects with NVD (N=6,904) were separated into three cohorts: OPC (N=2,552), ED (N=2,866) and ED-H (N=2,010). Patients were more likely to present to hospital compared to outpatient department if they were black (OR- 1.12), younger (OR-0.99), dialysis dependent (OR-1.02),underwent revisional surgery (OR- 1.32), were ASA category >2 (1.14), and/or have history of venous thromboembolism (OR- 1.35). However, of those patients that presented to the hospital, patients were more likely to be admitted if they were black (OR-1.51), older (OR-1.01), underwent revisional surgery (OR-1.33), were ASA category >3 (OR-1.47), and/or dialysis dependent (OR-4.89).
CONCLUSION: Following bariatric surgery, there are clinical (revisional surgery, ASA>3, dialysis dependent and VTE history) and non-clinical factors (race and age) that place a patient at an increased risk of requiring treatment for NVD. Understanding the relative contribution of these factors will help elucidate the differential utilization of healthcare resources, which is imperative to decrease waste in the system.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95706
Program Number: S073
Presentation Session: Residents and Fellows Session
Presentation Type: ResFel