Rafael Alvarez, MD1, Aaron J Bonham, MSc2, Arthur M Carlin, MD2, Oliver A Varban, MD1, Amir A Ghaferi, MD, MS1, Jonathan F Finks, MD1. 1University of Michigan, 2Michigan Bariatric Surgery Collaborative
Background: Patient-reported outcomes after bariatric surgery are important in understanding the longitudinal effects of surgery. The impact of hospital practices and surgical outcomes on follow-up rates remains unexplored.
Objective: To assess the effect of hospital-level practices and 30-day complication rates on 1-year follow-up rates of a standardized patient-reported outcomes survey.
Methods: Bariatric surgery program coordinators in a statewide quality improvement collaborative were surveyed in June 2017 about their practices for obtaining patient-reported outcomes data one year after surgery. Hospitals were ranked based on their follow-up rates between 2011 and 2015 (accounting for overall performance and improvement). Univariate analysis was used to identify hospital practices associated with higher follow-up rates. Multivariable regression was used to identify independent associations between 30-day outcomes and follow-up rates after adjusting for patient factors.
Results: Overall, follow-up rates improved from 2011 (33.9%±14.5) to 2015 (51.0%±13.0) though there was wide variability between hospitals (21.1% vs 77.3% in 2015). Coordinator survey response rate was 100%. Sixty-one percent of all surveyed coordinators perceived that surgeons prioritize high follow-up rates. When asked how long were their patients followed for, 78% of coordinators noted their programs provided lifelong follow-up. Patient reminders about the 1-year survey were used by 67% of programs, mostly during clinic visits (75%). Most programs (83%) had implemented strategies to improve follow-up rates, such as handing out the survey (73%) during clinic visits. Follow-up providers included surgeons (86%), nurse practitioners (56%), and/or registered dietitians (47%). Patient disinterest (81%), loss to follow-up (44%), survey length (36%), and lack of staff/resources (33%) were the factors most commonly perceived as barriers to high follow-up rates. When compared to programs in the bottom quartile of follow-up rates, those in the top quartile were more likely to hand out the survey to patients during clinic visits (100% vs 44.44%; p=0.0106) and had lower rates of risk-adjusted severe complications (1.79% vs 2.60%; p=0.0481), readmissions (3.96% vs 5.08%; p=0.0157), and reoperations (0.75% vs 1.50%; p=0.0216).
Conclusions: Hospitals vary considerably in their 1-year follow-up rates when seeking patient-reported outcomes data after bariatric surgery. There were also significant differences in program-specific practices for obtaining these data. Hospitals with higher 1-year follow-up rates were more likely to physically hand surveys to patients during a clinic visit and had lower 30-day severe complication, readmission, and reoperation rates. Improved 1-year patient-reported outcomes follow-up after bariatric surgery may be a proxy for higher quality perioperative care.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86681
Program Number: P555
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster