Trends in Emergency Department Utilization After Metabolic and Bariatric Surgery in the United States

In this article, we sought to understand the factors associated with emergency department (ED) utilization by patients after metabolic and bariatric surgery (MBS). The hopes were that modifiable risk factors could be identified to reduce ED visits after MBS.

We analyzed data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database (MBSAQIP) which is comprised of data from all nationally accredited bariatric centers in the United States. For our study, we included a population of 681 743 patients having undergone the 2 most common MBS procedures: sleeve gastrectomy (SG) and gastric bypass (GBP). Using logistic regression analysis, we identified key factors related to ED visits within 30 days of these procedures.

In our dataset, 7.1% of MBS patients had at least 1 ED visit, which is consistent with prior bariatric surgery studies. The most common reasons for ED visits were dehydration, urinary tract infections (UTIs), and surgical site infections (SSIs). Common comorbidities among the groups included conditions such as hypertension, sleep apnea, gastroesophageal reflux disease, and diabetes. The median time for the first ED visit was 11 days postoperatively. Our statistical analysis revealed significant associations between ED visits and dehydration, UTIs, and superficial SSI, but not with sex, race, robotic assistance, or trainee (resident) involvement.

The short time span between MBS surgery and postoperative ED visits suggests the need for outpatient follow-up to alleviate unnecessary ED visits. Further, our analysis identified the most frequent diagnosis that should guide the development of systematic follow-up protocols that can be used to identify those patients which may require additional post-surgical care.