Healthcare resource utilisation and predictors for critical care unit admissions after primary bariatric surgery in an Australian public hospital setting: an exploratory study using a mixed-methods approach

Objectives: An exploratory study that investigates resource use and predictors associated with Critical Care Unit (CCU) admission after primary bariatric surgery within the Tasmanian public healthcare system. Methods: Inclusion criteria was patients undergoing primary bariatric surgery in the Tasmanian Health Service (THS) public hospital system between 07/07/2013 and 30/06/2019. THS provides two levels of CCU support: Intensive Care Unit (ICU) and High Dependency Unit (HDU). A mixed-methods approach was performed to examine the resource use and predictors associated with the overall and levels of CCU/HDU/ICU admission. Results: N=254 patients entered the study. N=44 (17.3%) patients required 54 postoperative CCU admissions, with 43% requiring HDU support and 57% requiring more resource-demanding ICU support. Overall, CCU patients were more likely to have higher preoperative BMI, multimorbidity and undergo sleeve gastrectomy (SG) or gastric bypass (GBP). Patients undergoing gastric banding (GB) were more likely to require HDU rather than ICU support. Total hospital stays and median healthcare costs were higher for CCU patients (particularly ICU) than non-CCU patients. Conclusions: Bariatric surgery patients often have significant comorbidities. This work demonstrates that patients with higher levels of morbidity are more likely to require critical care postoperatively. As this is elective surgery, being able to identify patients who are at increased risk is important to plan either the availability of critical care or even interventions to improve their pre-operative risk. Further work is required to refine the pre-existing conditions that contribute most to those requiring critical care management (particularly in the ICU setting) in the perioperative period.