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Figure
Emergency utilization per quarter (13 weeks) in bariatric patients from Ontario operated during April 1, 2006, and March 31, 2011.
Abstract
Study objective
This study assessed long-term emergency care utilization after weight loss surgery.
Methods
We conducted a self-matched longitudinal cohort analysis of weight loss surgery patients in Ontario operated between April 1, 2006, and March 31, 2011. Using population-wide registries, we compared emergency visits in the 3-year interval after surgery to the 3 years before surgery using incidence rate ratios with 95% confidence intervals. The study excluded patients with repeat surgeries, and the analysis excluded visits in the immediate perioperative interval (ie, 3 months before and after surgery).
Results
A total of 8815 patients were identified of whom most were women (81%), living in an urban area (84%), and treated with gastric bypass (99%). Approximately half (53%) were aged 25 to 45 years. Approximately half of the patients 4364 (49%) had at least 1 emergency in both preoperative and postoperative intervals, 1417 (16%) in the preoperative interval only and 1661 (19%) in the postoperative interval only. Total emergencies significantly increased from 852 per 1000 patient-years to 1000 per 1000 patient-years, equal to an incidence rate ratio of 1.17 (95% confidence interval, 1.13-1.21; P < .001). Compared to baseline, emergencies from gastrointestinal, genitourinary, substance misuse, trauma, and miscellaneous complaints increased significantly after surgery. Conversely, emergencies due to cardiovascular, ear, respiratory, and dermatology complaints decreased significantly after surgery. Ambulance use, triage urgency, and hospitalizations were significantly higher for emergencies after surgery.
Conclusion
Persistent and resource-intensive emergency care utilization after weight loss surgery underscores the need of long-term patient support.
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☆Funding/support: This work was supported by the Canadian Institutes of Health Research, Canada Research Chair in Medical Decision Sciences (Donald A. Redelmeier), and the Da Souza Chair in Trauma Research (Avery B. Nathens). The funding agencies had no role in study design, conduct, analysis, or dissemination of findings.
☆☆Authors' contributions: Drs Bhatti and Redelmeier had full access to the data and take responsibility for accuracy of data analysis; study concept and design; acquisition, analysis, or interpretation of data; drafting of manuscript; and statistical analysis: all authors; administrative support, obtained funding, and supervision: Redelmeier and Nathens.
★Conflict of interest: No conflicts of interests were identified for any of the authors.
★★Ethics statement: Ethics approval of the study protocol was obtained from review boards of the Institute for Clinical Evaluative Sciences and the Sunnybrook Health Sciences Centre.
