Background

An important quality benchmark after bariatric surgery is 30-day Emergency Department visits. We aimed to identify risk factors for preventable Emergency Department (ED) visits after bariatric surgery.

Methods

Patients who underwent a minimally invasive sleeve gastrectomy between 2017 and 2022 at a single institution were identified. Patients who presented to the ED within 30 days after surgery were matched 1:3 to controls. Sociodemographic and clinical variables were collected from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database and the electronic medical record. Univariate conditional logistic regression analysis was applied to determine predictive factors of ED visits.

Results

Overall, 648 patients underwent sleeve gastrectomy, of which 53 (8.2%) presented to the ED within 30 days post-operatively. Patients that presented to the ED were more likely to be unemployed (42% vs 24%, p=0.04) and have government insurance (68% vs 41%, p=0.001). Significant risk factors included a lower versus upper socioeconomic bracket (OR 3.6, p=0.042), having a primary care physician (PCP) outside the health system versus within (OR 2.15, p=0.032), greater number of PCP visits within the past year (OR 1.27, p<0.001), and a greater number of post-operative clinic phone calls (OR 2.04, p<0.001). The number of ED visits within one year before surgery was also a significant risk factor, an odds ratio (OR) of 1.44 for each visit (p<0.001).

Conclusions

Both modifiable and unmodifiable risk factors contribute to Emergency Department visits after bariatric surgery. Identifying these risk factors can aid in the development of quality improvement initiatives.