A Multidisciplinary Approach to Reduce Postoperative Readmission After Bariatric Surgery in A Single Institution

Joon K Shim, MD, MPH, FACS1, G D Roye, MD, FACS1, Beth Ryder, MD, FACS1, Todd Stafford, MD1, Kellie C Armstrong, RN, BSN, MS, CBN2, Debi A Diana, MA2, Sivamainthan Vithiananthan, MD, FACS1. 1Brown University, 2Miriam Hospital

Introduction: Bariatric surgery patients are at a risk of requiring readmission after their index operation. In this study, we report a 14 month experience identifying and reducing postoperative readmissions within 30 days after bariatric surgery performed at a single teaching institution.

Methods: 272 morbidly obese patients underwent laparoscopic and open roux-en-y gastric bypass (LGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable LAP-BAND (LAGB) placement or revisional surgery from June 2012 – August 2013 at our bariatric center. Pre-intervention date was June 1, 2012 to Dec 31, 2012. Post-intervention date was Feb 1, 2013 to August 31, 2013. We established a multidisciplinary committee to review the readmission rate. All readmissions were reviewed. The majority of potentially avoidable readmissions were related to nausea and vomiting. Our readmission reduction process focused on the following key areas: additional teaching in our preoperative classes, outreach education to local visiting nurses, the addition of metoclopramide to our routine discharge medications, providing visiting nurses to all bariatric patients, increasing availability of dieticians, 24/7 availability of our bariatric nurse coordinator to all patients, having access to outpatient intravenous hydration, and making follow-up “Friday phone calls” to all bariatric patients.

Results: A total of 134 patients underwent bariatric surgery from June 1, 2012 to Dec 31, 2012. There were 12 readmissions during this period, 6 of which were related to nausea and vomiting. The multidisciplinary committee met and planned interventions in January 2013. From February 2013 to August 2013, a total of 138 patients underwent bariatric surgery, 7 of whom were readmitted. Only 1 patient was readmitted for nausea and vomiting. The overall post intervention readmission rate was 5.1%, down from 8.9% prior to our intervention. The post intervention readmission rate related to nausea and vomiting was 0.7%, down from 4.5% prior to our intervention.

Conclusion: A multidisciplinary committee can design and effectively implement a strategy to improve readmissions rates for bariatric surgery patients. As the majority of our readmissions were related to postoperative nausea, we saw a clear opportunity to target improvement. Engaging patients and improving the entire process of postoperative care to ensure compliance with these key measures are critical to a program’s success.

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