Background

Prior studies found significant use of the Emergency Department (ED) by patients after bariatric surgery (BS). However, how BS impacts ED usage, and which patients are most impacted is unknown. We hypothesize that persistent high use after BS is driven by a small subset of patients.

Methods

We queried the Colorado All Payers Claim Database. The primary outcome of interest was ED visits within 2 years post-op. BS was identified using CPT codes & diagnosis for ED visits using ICD codes. Patients were categorized by frequency of ED use preoperatively and postoperatively (>3 visits/year). Patients who became frequent users post-operatively were compared to those who did not.

Results

5,409 patients underwent BS from January 2013 - November 2017. While most patients infrequently used the ED before surgery and after surgery (n=4495, 83.1%), a small subset were infrequent users before surgery but developed new persistently high ED use for two years post-op (n=526, 9.7%, Figure). Factors associated with high use on multivariable modeling included Medicare or Medicaid vs. private insurance (OR 3.12 and 3.71, respectively, p<0.001), Roux-en-Y vs. sleeve gastrectomy (OR 1.53, p<0.001), postoperative length of stay >3 days (OR 1.52, p=0.02), and history of psychiatric disorders (OR 1.51, p<0.001). Increases in ED usage were mostly due to non-specific complaints (e.g. abdominal pain, dehydration, or gastrointestinal symptoms).

Conclusions

We identified a subset of patients (<10% overall) who drove increased ED utilization following BS. The majority of visits were for moderate symptoms which could be managed in outpatient clinics.