William P Main, DO1, Amy E Murphy, DO1, Lala R Hussain, MSc2, Katherine M Meister, MD1, Kevin M Tymitz, MD1. 1Good Samaritan TriHealth Hospital, 2TriHealth Hatton Research Institute
Introduction: The most common reasons for 30-day readmission following laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) are dehydration and nausea/vomiting. The primary objective of this study was to determine if implementing an outpatient infusion pathway (OIP) resulted in a decreased 30-day readmission rate in this patient population.
Methods: Data was prospectively gathered on all patients who underwent LRYGB and LSG at our bariatric center of excellence between April 1, 2015 and March 31, 2016 after instituting an OIP. OIP inclusion criteria were patients not able to take 40 ounces of fluid per day and/or persistent nausea 24 hours prior to discharge. OIP protocol included an antiemetic, 1 liter bolus of 0.9% saline, intravenous multivitamin, thiamine and folic acid. Thirty-day readmission rate, length of stay, and mortality rate were compared with patients who underwent LRYGB and LSG between January 1, 2014 and December 31, 2014 prior to implementing the OIP (pre-infusion group).
Results: A total of 309 patients were included for analysis, of which 174 underwent LRYGB and 135 underwent LSG. We compared 148 patients in the pre-infusion group to 161 patients in the post-infusion group. Of the 161 patients in the post-infusion group, 30 patients (18.6%) met inclusion criteria for the OIP. There was a 45% decrease in 30-day readmission rate following the institution of the OIP for patients who underwent LRYGB, however this was not statistically significant (11.39% vs 6.31%; OR 1.907; 95% CI 0.648-5.613, p=0.235). The 30-day readmission rate following LSG remained similar between cohorts (7.24% vs 7.57%; OR 0.953; 95% CI 0.263-3.456, p=0.942). There was no difference in postoperative length of stay (1.55 vs 1.35 days, p=0.074) or mortality (1.3% vs 0%, p=0.326) between pre-infusion and post-infusion groups, respectively.
Conclusion: Implementation of an OIP decreased 30-day readmission rate following LRYGB by 45%, however this was not statistically significant.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79064
Program Number: P486
Presentation Session: Poster (Non CME)
Presentation Type: Poster