title: Rates and Risk Factors for Unplanned Emergency Department Utilization and Hospital Readmission Following Bariatric Surgery.
abstract: OBJECTIVE
  To identify unplanned emergency resource utilization in the perioperative period following bariatric surgery.
  
  
  BACKGROUND
  Avoidable emergency department (ED) utilization and hospital readmissions pose a significant economic burden to our healthcare system. The extent of this problem is poorly studied in the bariatric literature.
  
  
  METHODS
  Using New York statewide longitudinal administrative data, 38,776 patients, who underwent primary bariatric surgery from 2010 to 2013, were analyzed. Multiple logistic regression models analyzed all variables with P < 0.05 on univariate models.
  
  
  RESULTS
  The 30-day unplanned ED utilization rate was 11.3% and 30-day hospital readmission rate was 5.3%. ED visits resulted in an inpatient admission 34.9% of the time. In total, 17.5% had 2 or more 30-day unplanned ED presentations. Patients presenting to the ED were more likely to be black, have pulmonary disease, be insured by the Centers for Medicaid and Medicare Services, travel further distances for index procedure, and have a surgical procedure other than gastric banding. In total, 46.7% presented to a nonindex hospital and 32.5% were admitted. Patients presenting to a nonindex hospital were significantly less likely to be admitted than those presenting to an index hospital.
  
  
  CONCLUSIONS
  Unplanned perioperative healthcare utilization is a significant burden incurred by the bariatric population. A clear opportunity is identified for improvement in healthcare delivery-particularly for high-risk and high-frequency utilizers. Presentation to nonindex hospitals has important implications to the accuracy of current patient safety and quality outcomes measures. System measures designed to capture all unplanned resource utilization, not just those to index hospitals, are crucial for accurate evaluation.
authors.affiliation: *Division of Foregut, Bariatric and Advanced GI Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY †Department of Preventative Medicine, Stony Brook University Medical Center, Stony Brook, NY ‡Office of Quality and Patient Safety, New York State Department of Health, Albany, NY §Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.forename: Maria
authors.initials: M
authors.lastname: Altieri
authors.forename: Wendy
authors.initials: W
authors.lastname: Patterson
authors.forename: Brittany
authors.initials: B
authors.lastname: Peoples
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.forename: Aurora D
authors.initials: AD
authors.lastname: Pryor
mesh_terms: D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009518:New York; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome