Factors associated with bariatric postoperative emergency department visits.
BACKGROUND
Unplanned bariatric postoperative emergency department (ED) visits occur frequently and may represent inadequate coordination of postdischarge care. Multicenter data on this outcome is limited, as this metric has not traditionally been tracked in large clinical databases.


OBJECTIVE
To describe the frequency of and risk factors associated with 90-day postoperative ED visits after bariatric surgery.


METHODS
Truven Health Analytics MarketScan database.


METHODS
All patients undergoing primary bariatric operations in the 2012 and 2013 MarketScan database were included. The primary outcome was the presence of an ED visit not resulting in a hospital readmission within 90 days of surgical discharge. Risk factors and demographic characteristics evaluated included age, sex, co-morbidities, insurance type, region, operation type, prior ED visits within 1 year, and index admission length of stay.


RESULTS
Postoperative ED visits not associated with an inpatient admission occurred in 14.6% of patients. The most common diagnoses associated with these visits were abdominal pain (24.4%) and dehydration, nausea, or vomiting (20.8%). On multivariate analysis, younger age, female sex, greater number of co-morbidities, north-central region, open bariatric or laparoscopic gastric bypass operations,≥2 prior ED visits, and increased initial length of stay were all associated with increased odds of an ED visit.


CONCLUSIONS
Postoperative ED visits are a frequent and potentially preventable occurrence with several risk factors. Tracking this metric as a quality indicator will allow for targeted interventions to improve the transition of care to the outpatient setting after bariatric surgery.
Department of Surgery, Boston Medical Center, Boston, Massachusetts. Electronic address: ryan.macht@bmc.org.
Ryan
R
Macht
Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
Judy
J
George
Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
Omid
O
Ameli
Department of Surgery, Boston Medical Center, Boston, Massachusetts.
Donald
D
Hess
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
Howard
H
Cabral
Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
Lewis
L
Kazis
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects*; D003681:Dehydration / Q000209:etiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D055815:Young Adult
Bariatric quality metric; Bariatric surgery; Emergency department use; Outcomes