Weight loss surgery and subsequent emergency care use: a population-based cohort study

Study Objective — This study assessed long-term emergency care utilization following 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 three year interval following surgery to the three years before surgery using incidence rate ratio (IRR) with 95% confidence intervals (CI). The study excluded patients with repeat surgeries and the analysis excluded visits in the immediate perioperative interval (i.e., three months before and after surgery).

Results — A total of 8,815 patients were identified of whom most were women (81%), living in an urban area (84%) and treated with gastric bypass (99%). About half (53%) were aged 25-45 years. About half of the patients 4 364 (49%) had at least one emergency in both pre- and post-operative interval, 1 417 (16%) in preoperative interval only, and 1 661 (19%) in the postoperative interval only. Total emergencies significantly increased from 852 per 1 000 patient-years to 1 000 per 1 000 patient-years, equal to an IRR = 1.17 (95% CI=1.13-1.21, P<0.001). Compared to baseline, emergencies from gastrointestinal, genitourinary, substance misuse, trauma and miscellaneous complaints increased significantly following surgery. Conversely, emergencies due to cardiovascular, ear, respiratory, and dermatology complaints decreased significantly following surgery. Ambulance use, triage urgency, and hospitalizations were significantly higher for emergencies following surgery.

Conclusion — Persistent and resource-intensive emergency care utilization following weight loss surgery underscores the need of long-term patient support.