Identifying drivers of emergency department overutilization following bariatric surgery: insights from the MBSAQIP.

Abstract

Background: Emergency department (ED) overutilization represents an avoidable source of increased health care costs. While bariatric surgery has low rates of postoperative complications, postoperative ED visits have been reported in 10%-15% of patients.

Objectives: We aimed to describe the prevalence, predictors, and timing of ED overutilization following bariatric surgery in addition to readmission patterns in ED overutilizers.

Setting: Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) centers of excellence across the United States.

Methods: Adult patients who underwent bariatric procedures from 2016 to 2022 were identified. Overutilization was defined as ≥2 ED visits without readmission within 30 days of surgery. Multivariable logistic regression, adjusting for patient and procedural characteristics, was used to determine predictors of overutilization and association with 30-day readmission. ED and readmission reasons in addition to days of ED visits and readmissions were characterized in the overutilization cohort.

Results: Of the 1,259,946 patients included, 11,818 (.9%) were ED overutilizers. ED overutilizers were predominantly female (88.7%) and had a mean age of 40.8 ± 11 years. Multivariable analysis revealed higher odds of ED overutilization in Black patients (1.30% vs. .84%, adjusted odds ratio [aOR]: 1.46, 95% confidence interval [CI]: 1.40-1.53) and those who underwent Roux-en-Y gastric bypass (1.39% vs. .75%, aOR: 1.74, 95% CI: 1.67-1.82). Postoperative pain (42.7%) and nausea and vomiting (34.5%) were the predominant diagnoses associated with ED visits. Overutilizers presented to the ED earlier compared to patients with only one ED visit (median days postoperatively (interquartile range): 8 (4, 14) versus 11 (5, 19), P < .001). Overutilizers were more likely to get readmitted than patients with no prior ED visits (17.2% vs. 2.9%, aOR: 5.75, 95% CI: 5.47-6.05).

Conclusion: ED overutilization following bariatric surgery represents a rare event that appears to be driven by potentially preventable causes including pain, nausea, and vomiting. Predictors of overutilization include patient demographics and procedure type. Understanding these drivers can guide targeted interventions to optimize postoperative care and reduce ED burden.