Presentations, management and outcomes of postoperative bariatric patients seen in the emergency department

Jessica Poliwoda; Amy Neville; Krishan Yadav; Marie-Joe Nemnom; Charlotte Grace Walmsley; Ian G Stiell

doi:10.1016/j.ajem.2024.04.033

Presentations, management and outcomes of postoperative bariatric patients seen in the emergency department

Am J Emerg Med. 2024 Apr 21:81:82-85. doi: 10.1016/j.ajem.2024.04.033. Online ahead of print.

Authors

Jessica Poliwoda¹, Amy Neville², Krishan Yadav³, Marie-Joe Nemnom⁴, Charlotte Grace Walmsley⁵, Ian G Stiell⁶

Affiliations

¹ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
² Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
³ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ Health Sciences Department, Wilfrid Laurier University, Waterloo, ON, Canada.
⁶ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. Electronic address: istiell@ohri.ca.

PMID: 38677198
DOI: 10.1016/j.ajem.2024.04.033

Abstract

Background: Bariatric surgery is becoming increasingly common and postoperative patients often present to the emergency department (ED) with complications. We sought to describe the presenting complaints, management, and outcomes of postoperative bariatric surgery patients seen in the ED.

Methods: We conducted a health records review of 300 consecutive postoperative Roux-en-Y bypass surgery patients who presented to two tertiary care EDs of a major bariatric surgery center within one year of surgery. Cases were identified using a data analytic tool, and two evaluators abstracted clinical variables, imaging, treatments, and outcomes using the electronic health record. Attending emergency physicians verified the data and an experienced bariatric surgeon interpreted the computed tomography (CT) results and surgical procedures.

Results: We included 300 patients with mean age 43.0 years, 89.7% female. Of these, 70.0% presented within 30 days of surgery and 41.7% were admitted to hospital. ED treatments included intravenous fluids (67.0%), antiemetics (53.3%), and analgesia (61.9%). Patients presenting within 30 days of surgery were more likely to undergo a CT (74.3% vs 63.3%; p = 0.06) and to have clinically important CT findings (31.9% vs 6.6%; p ≤0.001). More of the ≤30-day patients were admitted to hospital (46.2% vs 31.1%; p = 0.02). While a higher proportion of patients presenting after 30 days underwent a procedure, a large number of those were not directly related to bariatric surgery, such as appendectomy and cholecystectomy. Of the 34 patients undergoing a procedure, the majority presented with abdominal pain (76.5%).

Conclusion: This is the first detailed health records review of postoperative bariatric patients seen in the ED in the emergency medicine literature. Those presenting with abdominal pain were more likely to undergo CT abdomen and a surgical procedure. Similarly, those presenting within 30 days of surgery were more likely to have significant CT findings and require hospital admission. Others presenting with primarily nausea and vomiting may improve with ED symptom management and be discharged home with bariatric team follow-up.

Keywords: Bariatric surgery; Emergency department; Postoperative.