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Preventing Returns to the Emergency Department FollowingBariatric Surgery

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Abstract

Background

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.

Methods

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.

Results

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%).

Conclusions

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.

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Authors and Affiliations

  1. 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, Yan Zhai, James O’Loughlin, Rebecca Kholer, Ellen Morrow, Robert Glasgow, Eric Volckmann & Anna Ibele

  2. Department of Psychology, University of Utah and Affiliated Hospitals, Salt Lake City, UT, USA

    Justin Mackenzie

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  1. Jennwood Chen
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  2. Justin Mackenzie
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Correspondence to Jennwood Chen.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required.

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Does not apply.

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Chen, J., Mackenzie, J., Zhai, Y. et al. Preventing Returns to the Emergency Department FollowingBariatric Surgery. OBES SURG 27, 1986–1992 (2017). https://doi.org/10.1007/s11695-017-2624-7

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  • DOI: https://doi.org/10.1007/s11695-017-2624-7

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