Samuels Jason M, Helmkamp Laura, Carmichael Heather, Rothchild Kevin, Schoen Jonathan
Department of Surgery, University of Colorado Anschutz, Aurora, Colorado.
The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz, Aurora, Colorado.
Surg Obes Relat Dis. 2021 Aug;17(8):1465-1472. doi: 10.1016/j.soard.2021.04.016. Epub 2021 Apr 28.
Prior studies have found rates of emergency department (ED) visits after bariatric surgery approach 15% with the majority (>60%) not requiring admission. The timeframe for which ED utilization remains elevated postoperatively remains unknown. We hypothesize that ED utilization following bariatric surgery remains elevated for months after surgery with the majority of visits not requiring admission.
No study has determined the impact bariatric surgery has on health care resource utilization in the two years following surgery. The aim of this study is to determine the frequency of ED visitation in the 2 years following bariatric surgery.
Database study, single state-wide insurance database.
We queried the Colorado All Payers Claim Database. Patients with data 1 year before and 2 years after surgery were included. Primary outcomes of interest were ED visits or readmissions during the 2-year period. Bariatric surgeries were identified using CPT codes. Diagnoses for an ED visit or readmission were determined by ICD codes.
A total of 5399 patients underwent bariatric surgery from January 2013-November 2017. Of these, 59% underwent sleeve gastrectomy, 38% Roux-en-Y, 2% gastric band, and 1% another surgery. Median age was 44 (IQR 35-54) years, and 82% were female. Overall, 3103 patients (57%) visited the ED at least once with a total of 12,988 visits, 1267 of which (9.8%) resulted in admission. ED use was highest in the 30 days following surgery (17%) but remained above presurgery baseline for 8 months (7.4% at 8 mo compared with baseline mean 6.4% [95% CI 6.0%-6.8%]).
ED visits remain elevated for 8 months post bariatric surgery with over 90% of visits not requiring an admission. Interventions that prevent emergency department utilization should be key focus of quality improvement projects to limit health care resource utilization following bariatric surgery.
先前的研究发现，减肥手术后急诊就诊率接近15%，其中大多数（>60%）无需住院。术后急诊利用率仍居高不下的时间范围尚不清楚。我们假设减肥手术后急诊利用率在术后数月内仍居高不下，且大多数就诊无需住院。
尚无研究确定减肥手术对术后两年内医疗资源利用的影响。本研究的目的是确定减肥手术后两年内急诊就诊的频率。
数据库研究，单一全州范围保险数据库。
我们查询了科罗拉多州所有支付方索赔数据库。纳入手术前1年和手术后2年有数据的患者。主要关注的结局是两年期间的急诊就诊或再入院情况。使用CPT编码识别减肥手术。急诊就诊或再入院的诊断由ICD编码确定。
2013年1月至2017年11月共有5399例患者接受了减肥手术。其中，59%接受了袖状胃切除术，38%接受了Roux-en-Y胃旁路术，2%接受了胃束带术，1%接受了其他手术。中位年龄为44（四分位间距35 - 54）岁，82%为女性。总体而言，3103例患者（57%）至少就诊过一次急诊，共就诊12988次，其中1267次（9.8%）导致住院。急诊使用率在术后30天最高（17%），但在8个月内仍高于术前基线水平（8个月时为7.4%，而基线平均水平为6.4% [95%置信区间6.0% - 6.8%]）。
减肥手术后急诊就诊率在术后8个月内仍居高不下，超过90%的就诊无需住院。预防急诊就诊的干预措施应成为质量改进项目的关键重点，以限制减肥手术后的医疗资源利用。
