M. C. Mora Pinzon1, D. Henkel6, R. E. Miller2, P. L. Remington1, S. N. Kothari4, J. Gould3, L. M. Funk5,6 1University Of Wisconsin,School Of Medicine And Public Health,Madison, WI, USA 2Wisconsin Department Of Health Services,Madison, WI, USA 3Medical College Of Wisconsin,Department Of Surgery,Milwaukee, WI, USA 4Gundersen Health System,Department Of Surgery,Milwaukee, WI, USA 5William S. Middleton VA Hospital,Madison, WI, USA 6University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction: 30-day complication and readmission rates following bariatric surgery are well reported. However, there are limited data regarding bariatric surgery readmissions and Emergency Department (ED) utilization beyond 30 days. In this study, we identified all ED visits and readmissions to any facility in Wisconsin within one year of bariatric surgery, and we examined patient and hospital characteristics associated with these visits.
Methods: Statewide hospital patient data collected by the Wisconsin Hospital Association were used to identify all obese patients >20 years old who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (LSG) from 2011-2014. Patient demographics, complications during bariatric surgery hospitalization, and primary and secondary diagnoses were identified using the International Classification of Diseases, Ninth Revision (ICD-9). Iterative deterministic linkage was used to track individuals who subsequently received hospital care over the next year. Bivariate associations between patient/hospital factors and ED visit or readmission were examined. Factors significant at a p<0.1 were included in a multivariable logistic regression model.
Results: 5,701 procedures were identified: 70% RYGB (n=3,988), 30% LSG (n=1,713). 79% of the patients were female. The mean age was 45.7 years old (SD: 11.5). 39% of patients presented to the ED or were readmitted within one year of bariatric surgery. The frequency of ED visits during the first year ranged from 10.7% in the first 30 days to 5.7% during postoperative days 181-270. Readmission rates ranged from 4.4% in the first 30 days to 2.7% during postoperative days 91-180 (Figure). On multivariable analysis, an ED visit within 1 year of bariatric surgery was associated with younger age, female gender, RYGB (vs. sleeve), having ≥4 comorbidities, Medicare or Medicaid insurance, teaching hospital for index procedure, and experiencing a complication during the initial bariatric surgery hospitalization (all p <0.05). Readmission within one year was associated with male gender, RYGB, ≥4 comorbidities, Medicare insurance, teaching hospital, and complication during the initial bariatric surgery hospitalization (all p <0.05).
Conclusion: ED visits and hospital readmissions are more common within the first 30 days after bariatric surgery, but persist steadily throughout the first postoperative year. Quality improvement efforts focused on patients who are most likely to visit the ED or be readmitted – such as those who undergo a gastric bypass or experience a complication during their bariatric surgery admission – may improve outcomes and decrease hospital resource utilization.
