Estimated Exercise Workload is a Predictor for Emergency Department Visits Following Bariatric Surgery

Background: Peak functional capacity is an independent predictor of mortality and preoperative-surgical risk. We sought to examine the relationship between estimated exercise training workload and complications after bariatric surgery. Methods: Patients who participated in an exercise class prior to bariatric surgery at a single institution between January 2015 and June 2018 were included in the analysis. Exercise was led by a clinical exercise physiologist who guided exercise intensity based on patient perceived exertion. Workloads performed on a treadmill or a seated recumbent stepper (i.e., NuStep) were converted to metabolic equivalents of task (METS) using validated equations. An odds ratio (OR) was calculated to predict if exercise METS were related to the following events: emergency department (ED) visits, hospital readmission, length of stay, or surgical complications. Results: 684 patients were included in the analysis (age = 45 + 10 yr; BMI = 47 + 7 kg/m2). The majority of patients were female (84%) and underwent sleeve gastrectomy (73%). 57 events were observed (8.3%), the majority of which were 30-day ED visits (44 events). Estimated METS during exercise training were predictive of both overall events, as well as 30-day ED visits (Table). After adjustment, METS remained predictive of 30-day ED visits. Values below 2.7 METS were related to the highest risk. Conclusion: Higher exercise METS levels prior to bariatric surgery were predictive of lower 30-day ED visit rates, with each 1 MET increase associated with a 48% reduction in risk. Pre-operative exercise training workload may help further stratify surgical risk