Date of Award

Spring 5-1-2022

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Technology Management

Department

College of Technology

Abstract

One of US hospitals' widely used critical performance or quality outcome measures is the 30-day emergency department (ED) visit after a surgical procedure. Such ED visits add millions of dollars each year as a cost burden to US healthcare. This study aimed to identify key predictors known before the patient's surgery, contributing to undesirable ED visits within 30 days of a bariatric surgical procedure. The study was conducted in three phases. The first phase of the study engaged a panel of experts to narrow down important preoperative factors for patients undergoing bariatric surgery in the form of a Delphi study. The second phase of the study included quantitative data analysis, which utilized the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Data File of the year 2019 to identify statistically significant preoperative factors that can contribute to the likelihood of patients returning to the emergency department within 30 days of bariatric surgery. There were N = 193,774 cases with complete information from 868 MBSAQIP-accredited bariatric surgery centers across the United States in the Data File among which 15,533 (8% of the total cases) visited an ED without needing admission as inpatients. The analysis also examined the feasibility of developing a predictive model with only statistically significant factors and checking if the model has an acceptable fit. The third phase of the study reengaged the same panel of experts from the first phase to validate the findings from the second phase and to document the subject matter experts' perception regarding the model developed and the overall findings. Out of 33 preoperative variables, only 9 variables were selected in the first phase of the study iv with the help of a panel of experts. Out of the 9 chosen variables, 8 variables, i.e., Pre-Op GERD requiring medication, Number of Hypertensive Medications, Pre-Op BMI closest to bariatric surgery, Highest Recorded Pre-Op BMI, Pre-Op vein thrombosis requiring therapy, Pre-Op diabetes mellitus, Pre-Op history of COPD, and Pre-Op Steroid/Immunosuppressant Use for Chronic Condition significantly contributed to the likelihood of patients coming back to ED within 30 days of bariatric surgery. The study's second phase also yielded a predictive model using only the statistically significant and weighted variables, and each predictor exhibited statistical significance. In the third phase, a panel of experts weighed in mostly with positive feedback deeming the study clinically and operationally valuable for the bariatric patient population. The practical implication of this study is that the MBSAQIP Centers can use the model to determine the probability of a patient's likelihood of returning to ED after a bariatric surgical procedure. Based on the set criteria, if the patient has a higher chance of returning to ED, the care team can take interventions during and in the first few days or weeks of the discharge to prevent potential postoperative ED visits within 30 days of bariatric surgery.

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