Ryan Macht1, Judy George2, Omid Ameli2, Donald Hess3, Howard Cabral4, Lewis Kazis2. 1. Department of Surgery, Boston Medical Center, Boston, Massachusetts. Electronic address: ryan.macht@bmc.org. 2. Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts. 3. Department of Surgery, Boston Medical Center, Boston, Massachusetts. 4. Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
Abstract
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. OBJECTIVES: To describe the frequency of and risk factors associated with 90-day postoperative ED visits after bariatric surgery. SETTING: 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.
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. OBJECTIVES: To describe the frequency of and risk factors associated with 90-day postoperative ED visits after bariatric surgery. SETTING: 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.
Authors: Ryan D Horsley; Ellen D Vogels; Daaron A P McField; David M Parker; Charles Medico; James Dove; Marcus Fluck; Jon D Gabrielsen; Michael R Gionfriddo; Anthony T Petrick Journal: Obes Surg Date: 2019-02 Impact factor: 4.129
Authors: Jennwood Chen; Justin Mackenzie; Yan Zhai; James O'Loughlin; Rebecca Kholer; Ellen Morrow; Robert Glasgow; Eric Volckmann; Anna Ibele Journal: Obes Surg Date: 2017-08 Impact factor: 4.129