Yen-Yi Juo, MD, MPH, Yas Sanaiha, MD, Yijun Chen, MD, Erik Dutson, MD. UCLA
Introduction: Bariatric surgeries are commonly performed in accredited Centers of Excellence, but no consensus exists regarding the optimal readmission destination when complications occurred. Our study aims to examine the impact of care fragmentation on post-operative outcome and evaluate its causes and consequences among patients undergoing 30-day readmission after bariatric surgery.
Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2015 database was used to identify patients who experienced 30-day unplanned readmission following bariatric surgery. Non-index readmission was defined as any readmission occurring at a hospital other than the one where initial surgery was performed. Primary outcome was 30-day mortality after surgery. Logistic regressions were used to identify risk factors for non-index readmission and to adjust for confounders in the association between non-index readmission and 30-day mortality.
Results: A total of 5,276 patients were identified as experiencing 30-day unplanned readmission following bariatric surgery, among whom 359 (6.8%) were non-index readmissions. Occurrence of postoperative complication during initial hospitalization was the most significant risk factor for non-index readmission (OR 1.36, 95% CI 1.06-1.75, p=0.02) in our multivariate logistic regression. The three most common reasons for readmission were similar within the two comparison groups, including nausea/vomit, abdominal pain and anastomotic leakage. Similar proportion of patients underwent reoperation among the two comparison groups (22.7 vs 20.6%, p=0.362). Even after adjusting for occurrence of complications, being readmitted to a non-index facility was still associated with a 5.2-fold odds of 30-day mortality (95% CI 2.50-10.85, p<.001).
Conclusion: Non-index readmission significantly increases the risk of 30-day mortality following bariatric surgery. Patients were more likely to visit a non-index facility if complications occurred during their initial hospitalization. Further patient education is required to re-inforce the importance of continuity-of-care during management of bariatric complications and guide patient’s decision making in choosing readmission destinations.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86667
Program Number: P544
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster