• Alexander Khouri, Rafael Alvarez, Niki Matusko, and Oliver Varban.
• Medical School, University of Michigan, Ann Arbor, Michigan. Electronic address: khouria@umich.edu.
• Surg Obes Relat Dis. 2020 Jan 1; 16 (1): 48-55.

BackgroundPatients who present to the emergency department (ED) after bariatric surgery may incur significant costs with no additional benefit.ObjectivesTo characterize patients who presented to the ED but could have been treated in an alternative setting.SettingUniversity hospital, United States.MethodsWe identified 131 patients who underwent primary bariatric surgery at a single-center academic institution between 2006 and 2016 who also presented to the ED within 30 days of surgery. Preventable ED visits were identified by excluding patients with life-threatening presentations and/or use of emergent ED-specific resources. Patients with preventable ED visits were matched 1:1 to controls (no ED visit) based on procedure type and preoperative patient characteristics. Independent risk factors among patients with preventable ED visits were identified.ResultsA total of 80 patients (61%) were identified as having a preventable ED visit after bariatric surgery. After multivariable logistic regression, independent risk factors associated with preventable ED visits included anxiolytic prescription at discharge (odds ratio [OR] 5.4 [95% confidence interval 1.6-18.6]; P = .007), electrolyte abnormalities (OR 4.3 [1.9-9.6]; P < .0001), and leukocytosis (OR 2.2 [1.0-4.9]; P = .048) at discharge, and number of ED visits preoperatively (OR 2.0 [1.3-3.1]; P = .001). Severe complications, reoperation rates, and 1-year patient reported outcomes did not differ between patients with preventable ED visits and their matched cohort.ConclusionsPreventable ED visits are common after bariatric surgery and are associated with risk factors that can be identified perioperatively. Identifying and triaging patients at risk for preventable ED visits may decrease unnecessary and costly visits to the ED after bariatric surgery.Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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