Background

ED overutilization represents an avoidable source of increased healthcare costs. While bariatric surgery has low rates of postoperative complications, postoperative ED visits have been reported in 10-15% of patients. In this study, we aimed to report the frequency of ED overutilization following bariatric surgery, in addition to identifying predictors and reasons for ED visits, and timing of recurrent visits.

Methods

The MBSAQIP national database was queried to identify adult patients who underwent bariatric procedures from 2016 to 2022. Overutilization was defined as two or more postoperative ED visits that did not result in an admission. Multivariable logistic regression was used to determine predictors of overutilization. ED discharge diagnoses were characterized in the overutilization cohort.

Results

Of the 1,272,652 patients included, 11,923 (0.9%) were ED overutilizers and predominantly female (88.7%) with a mean age of 40.8+-11 years. Multivariable analysis revealed that Black patients and those who underwent Roux-en-Y gastric bypass had higher odds of ED overutilization (aOR: 1.49, p<0.001, and aOR: 1.75, p<0.001). Postoperative pain, nausea, and vomiting were the predominant diagnoses associated with ED visits (Figure 1). Overutilizers presented to the ED earlier compared to patients with only one ED visit (mean: 9.7 vs. 12.7 days, p<0.001).

Conclusions

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, comorbid conditions, and procedure type. Understanding these drivers can guide targeted interventions to optimize postoperative care and reduce ED burden.