Emergency department visits and readmissions within 1 year of bariatric surgery: A statewide analysis using hospital discharge records.

BACKGROUND: Data are limited regarding emergency department visits and readmission rates beyond 30 days after bariatric surgery. We analyzed emergency department visits and readmissions to all facilities in Wisconsin within 1 year of bariatric surgery and identified their predictors. METHODS: All adults who underwent a laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy from 2011-2014 were identified. Bivariate associations between patient/hospital factors and emergency department visits/readmissions were examined, and factors significant at P < .1 were included in multivariable logistic regression models. RESULTS: Within 1 year of bariatric surgery, 36.9% of emergency department visits and 60.3% of readmissions were to the same institution in which bariatric surgery was performed. The frequency of emergency department visits ranged from 10.7% (postoperative days 0-30) to 5.7% (postoperative days 181-270). Readmission rates ranged from 4.4% (postoperative days 0-30) to 2.7% (postoperative days 91-180). Readmission within 1 year was associated with male sex, Roux-en-Y gastric bypass, ≥4 comorbidities, Medicare insurance, teaching hospitals, and inpatient complications (all P < .05). CONCLUSION: Emergency department visits and readmissions persist throughout the first year at a relatively steady rate after 30 days and often do not occur where bariatric surgery was performed. Quality improvement efforts targeting these patients may improve outcomes and decrease hospital resource utilization.

Trends in the Prevalence of Severe Obesity and Bariatric Surgery Access: A State-Level Analysis from 2011 to 2014.

BACKGROUND: Understanding what proportion of the eligible population is undergoing bariatric surgery at the state level provides critical insight into characterizing bariatric surgery access. We sought to describe statewide trends in severe obesity demographics and report bariatric surgery volume in Wisconsin from 2011 to 2014. METHODS: Self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS) were used to calculate prevalence rates of severe obesity (class II and III) in Wisconsin. Bariatric surgery volume data were analyzed from the Wisconsin Hospital Association. A survey was sent to all American Society for Metabolic and Bariatric Surgery member bariatric surgeons in Wisconsin to assess perspectives on bariatric surgery access, insurance coverage, and referral processes. RESULTS: The prevalence of severe obesity in Wisconsin increased by 30% from 2011 to 2014 (10.4%-13.2%; P = .035); the odds of severe obesity nearly doubled for adults age 20-39 (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.3-3.0). During this time, the volume of bariatric surgery declined by 4.2%; (1432 to 1372; P < .001), whereas the rates of bariatric surgery per 1000 persons with severe obesity declined by 25.7% (3.5 to 2.6/1000). A majority (72%) of bariatric surgeon respondents felt bariatric surgery access either worsened or remained the same over the last 4 years. CONCLUSIONS: Severe obesity increased significantly in Wisconsin over a 4-year period, whereas bariatric surgery rates among severely obese persons have remained largely unchanged and are substantially below the national average. Combining the state-level obesity survey data and bariatric surgery administrative data may be a useful approach for tracking bariatric surgery access throughout the United States.

Trends in bariatric surgery for morbid obesity in Wisconsin: a 6-year follow-up.

BACKGROUND: The prevalence of morbid obesity is increasing throughout Wisconsin and the United States. In 2004, we published a study, "Trends in Bariatric Surgery for Morbid Obesity in Wisconsin." We determined that surgery rates were increasing but felt the demand exceeded the capacity of the surgeons. This is a 6-year follow-up. METHODS: Data was gathered from 3 sources: the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, the Wisconsin Hospital Association, and a survey administered to Wisconsin bariatric surgeons. RESULTS: From 2003-2008, an average of 2.8% of Wisconsin adults were morbidly obese. Although the number of bariatric surgeries performed in Wisconsin remained steady (1311 surgeries in 2003 and 1343 in 2008), the types of procedures shifted from open gastric bypass (73% in 2003) to laparoscopic gastric bypass (80% in 2008). The rate of surgery was 1 for every 100 morbidly obese adults. The majority of surgeons surveyed (70%) report that a lack of insurance benefits is the biggest barrier to performing bariatric surgery. CONCLUSION: The prevalence of morbid obesity continues to increase in Wisconsin compared to our previously published data. Bariatric surgery volumes have remained stable but the type of procedure has changed. Approximately 1% of bariatric surgery candidates have surgery each year.