title: A Comparison of Bariatric Surgery in Hospitals With and Without ICU: a Linked Data Cohort Study.
abstract: BACKGROUND
  It is uncertain whether bariatric surgery can be safely performed in secondary hospitals without on-site intensive care unit (ICU) support. This study describes the outcomes of elective bariatric surgery patients who required inter-hospital transfers for unplanned ICU management, extrapolating this as a parameter for secondary hospital safety after bariatric surgery.
  
  
  METHODS
  This was a retrospective, statewide, population-based, linked data cohort study capturing all adult bariatric surgery patients for an entire Australian state between 2007 and 2011 (n = 12,062) with minimum 12-month follow-up.
  
  
  RESULTS
  In secondary hospitals, 2663 (22.1%) bariatric patients were operated on, with the majority (n = 2553) undergoing sleeve gastrectomies (SG) or adjustable gastric bands (LAGB). Forty-two patients (including 19 LAGB and 20 SG) required inter-hospital transfer to a tertiary hospital for unplanned ICU care (1.6%, 95% confidence interval 1.2-2.1), mainly due to surgical complications. Inter-hospital transfers incurred two deaths, both following sleeve gastrectomies. When compared to patients requiring unplanned ICU admissions after bariatric surgery in tertiary hospitals with an on-site ICU (n = 155), there was no difference in their demographic parameters, comorbid illnesses, or mortality (4.8 vs 3.9%, p = 0.68). The mortality following bariatric procedures both statewide (0.2%) and in secondary hospitals (0.2%) was both uncommon and comparable.
  
  
  CONCLUSIONS
  Statewide inter-hospital transfers for unplanned ICU care from secondary hospitals were low. Inter-hospital transfer mortality was comparable to a similar bariatric cohort requiring unplanned ICU care after surgery in a tertiary hospital. This suggests that certain bariatric procedures can be safely done in most secondary hospitals where elective ICU admission is deemed unnecessary.
authors.affiliation: Department of Intensive Care Medicine, St John of God Hospital Subiaco, 12 Salvado Road, Subiaco, Western Australia, 6008, Australia. davidintoronto2004@hotmail.com.
authors.forename: David J R
authors.identifier: http://orcid.org/0000-0002-7410-6591
authors.initials: DJ
authors.lastname: Morgan
authors.affiliation: Department of Intensive Care Medicine, St John of God Hospital Subiaco, 12 Salvado Road, Subiaco, Western Australia, 6008, Australia.|School of Population Health, University of Western Australia, Nedlands, Western Australia, Australia.|School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia.
authors.forename: Kwok M
authors.initials: KM
authors.lastname: Ho
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D010360:Patient Transfer / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014904:Western Australia / Q000453:epidemiology
keywords: Critical care; Hospital safety; Obesity; Outcomes; Secondary hospital