H. Abdel Khalik1, H. Stevens1, A. M. Carlin2, A. Stricklen1, R. Ross1, C. Pesta3, A. Ghaferi1 1University Of Michigan,General Surgery,Ann Arbor, MI, USA 2Wayne State University,Detroit, MI, USA 3McLaren Macomb Hospital,Mt. Clemens, MI, USA
Introduction:
Many emergency department (ED) visits following bariatric surgery do not result in readmission and may be preventable. Little research exists evaluating the efficacy of perioperative measures aimed at reducing ED visits in this population. Therefore, understanding the driving factors, such as patient and hospital characteristics, behind these preventable ED visits may be a fruitful approach to prevention. Furthermore, evaluating the efficacy of current perioperative measures may shed light on how to achieve meaningful reductions in ED visits.
Methods:
We studied 48,035 eligible patients who underwent bariatric surgery at across 37 Michigan Bariatric Surgical Collaborative (MBSC) sites between January 2012 and October 2015. Hospitals were ranked according to their risk-and reliability-adjusted ED visit rates. For hospitals in each ED visit rate tercile, several patient, surgery and hospital summary characteristics were compared. We then studied whether a hospital’s compliance with specific perioperative measures was significantly associated with reduced ED visit rates.
Results:
We found that only three of the 30 surgery, hospital, and patient summary characteristics studied were significant predictors of a hospital’s ED visit rate: rate of sleeve gastrectomies, rate of readmissions, and rate of VTE complications (p= 0.04, p=0.0065 and p=0.0047, respectively). Also, a hospital’s compliance with the perioperative measures evaluated was not a significant predictor of ED visit rates (p=.12).
Conclusion:
Current practices aimed at reducing ED visits appear to be ineffective. Due to heterogeneity in patient populations and local infrastructure, a more tailored approach to ED visit reduction may be more successful.