title: Preventing Returns to the Emergency Department FollowingBariatric Surgery.
abstract: Unnecessary emergency department (ED) visits following bariatric surgery represent a significant source of inefficient resource utilization. This study aimed to identify potential strategies aimed at preventing unnecessary returns to the ED following bariatric surgery. The study was conducted in University Hospital, USA.
  
  
  
  The electronic medical records of all patients who underwent bariatric surgery at our institution between January 2011 and October 2015 were retrospectively reviewed. Information regarding procedure, gender, age, preoperative BMI, obesity-related comorbid conditions, postoperative length of stay (LOS), and reasons for ED visits within 90 days of surgery were obtained. Six practitioners (four attending surgeons, one resident physician, and one physician assistant) independently reviewed patient chief complaint and clinical findings at the time of ED returns. Reasons for ED return were scored as either preventable or non-preventable. "Preventable" denoted that an ED return could potentially be avoided by means of a system change in our bariatric practice.
  
  
  
  Our institution performed 361 bariatric procedures during the study period. Of these, 65 patients had 91 ED visits, 23 of which resulted in readmissions, and two of which required operative interventions. The ≤90-day all-cause postoperative ED visit rate was 18% (n = 65). Of the 91 ED visits, 47% were deemed preventable (n = 43). The most common preventable reasons for ED returns were nausea, vomiting, dehydration (NVD) (27.9%), postoperative pain (25.6%), wound evaluations (20.9%), and compliance issues (14%).
  
  
  
  Postoperative ED visits following bariatric surgery are prevalent and costly. Many of these visits are potentially preventable. Implementing outpatient strategies to address these causes will likely attenuate inefficient resource utilization.
authors.affiliation: Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA. Jennwood.chen@hsc.utah.edu.
authors.forename: Jennwood
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Psychology, University of Utah and Affiliated Hospitals, Salt Lake City, UT, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Mackenzie
authors.affiliation: Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhai
authors.affiliation: Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA.
authors.forename: James
authors.initials: J
authors.lastname: O'Loughlin
authors.affiliation: Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kholer
authors.affiliation: Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Morrow
authors.affiliation: Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Glasgow
authors.affiliation: Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Volckmann
authors.affiliation: Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Ibele
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D010149:Postoperative Pain; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Bariatric surgery; Co-morbidity; Emergency department utilization; Gastric bypass; Laparoscopy; Logistic regression; PPR; Preventable; Readmission; Risk factors; Sleeve resection