The readmission contradiction: toward clarifying common misconceptions about bariatric readmissions and quality improvement

Petrick, Anthony; Brindle, Shannon; Vogels, Ellen; Dove, James T.; Parker, David M.; Gabrielsen, Jon

doi:10.1016/j.soard.2018.02.017

Cited by 8 publications

(5 citation statements)

References 7 publications

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“…Fever was the indication for ED visits in 6% of patients in the present study, which was half the rate reported by other investigators 32. A number of studies reported an association between gastrointestinal symptoms, such as nausea and vomiting, and ED visits 17,36,37. It is evident that gastrointestinal and diet-related symptoms are common causes of ED visits after bariatric surgery.…”

Section: Discussionsupporting

confidence: 52%

“…32 A number of studies reported an association between gastrointestinal symptoms, such as nausea and vomiting, and ED visits. 17,36,37 It is evident that gastrointestinal and dietrelated symptoms are common causes of ED visits after bariatric surgery. Dietary indiscretion and dehydration are the main factors in the pathogenesis of these symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Emergency Department Visits and Unplanned Readmission After Bariatric Surgery: An Experience From a Tertiary Referral Center

Makki

Mahdy

Emile

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Bariatric surgery is the most effective treatment of morbid obesity. As the number of bariatric procedures performed has increased, visits to the emergency department (ED) and readmissions have subsequently increased. The present study aimed to assess the rates and indications for of ED visits and readmission after bariatric surgery and to identify the predictors of hospital readmission.Patients and Methods: This was a retrospective cohort study on patients who underwent bariatric surgery from January 2018 to April 2020. The percentage of ED visits and unplanned readmission was estimated and the indications and management of each were analyzed. The association of age, sex, body mass index, and type of procedure with readmission was assessed.Results: Of 582 patients who underwent bariatric surgery in the study period, 204 (35%) required ED visits, and 42 (7.2%) required readmission. The mean age of patients was 33 years, and the mean body mass index was 43 kg/m 2 . The most common indication for ED visits was abdominal pain (41.2%). In all, 64.8% of ED visits and 43% of readmissions were unrelated to bariatric surgery complications. A total of 94.1% of patients who required ED visits and 71.4% of readmitted patients were managed conservatively. The most common procedure followed by readmission was laparoscopic sleeve gastrectomy (50%) then one-anastomosis gastric bypass (21.4%). Age, sex, body mass index, and procedure type were not significantly associated with higher readmission. Conclusions:The rates of ED visits and readmission in our cohort were 35% and 7.2%, respectively. Most cases of ED visits were not related to adverse effects of bariatric surgery and the majority of which were managed conservatively.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Analysis of Emergency Department Visits and Unplanned Readmission After Bariatric Surgery: An Experience From a Tertiary Referral Center

Makki

Mahdy

Emile

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Thirty-day readmission rates serve as a critical metric of both quality and cost for accredited programs 3 and have become the focus of many improvement efforts. Of the 4.4% of patients readmitted nationally, 4 up to half are thought to be preventable, 5 and over one-third are accounted for by gastrointestinal symptoms, including nausea and vomiting, electrolyte or nutritional depletion, and dehydration. 4,[6][7][8] Widespread efforts to improve outcomes and reduce postoperative readmissions have focused on preoperative education, process improvement, 3,9,10 and the use of perioperative protocols, 11 with moderate success.…”

Section: Introductionmentioning

confidence: 99%

Change in Total Body Water as a Metric for Predicting Need for Outpatient Intravenous Fluids in Postoperative Bariatric Patients

Matevish

Hawkins

Bethurum

et al. 2020

The American Surgeon

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Background Dehydration drives a significant proportion of readmissions following bariatric surgery. Routinely performed body composition testing and total body water (TBW) calculations may present a novel method for diagnosing dehydration for outpatient intervention. We sought to determine if a change in TBW from preoperative baseline could help identify bariatric patients requiring outpatient intravenous fluid (IVF) administration for dehydration. Methods The VUMC Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was retroactively queried for all patients undergoing bariatric surgery at an accredited bariatric surgery center from January 1, 2017 to May 31, 2018. Body composition test results presurgery and postsurgery were extracted from the electronic health record. Change in TBW was compared between patients requiring outpatient IVF and those who did not use multivariable logistic regression. Results 583 patients underwent surgery over the study period (388 laparoscopic Roux-en-Y gastric bypass, 195 sleeve). 62 (10.6%) required outpatient fluid administration for dehydration. After multivariable analysis, patients with an increased hospital length of stay at index operation were more likely to require outpatient IVF (odds ratio [OR] 1.65, 95% CI 1.22-2.2). Preexisting diabetes diagnosis was protective (OR 0.35, 95% CI 0.16-0.74). Neither 1-week nor 1-month change in TBW from preoperative baseline was significantly different between patients receiving outpatient IVF and those who did not. Conclusion Increased hospital length of stay predicts patients at risk of postoperative dehydration requiring IVF administration. Body composition testing and TBW were not useful in distinguishing between populations. Further research is needed to examine the efficacy of outpatient IVF in preventing hospital readmissions for dehydration.

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“…For example, one study found that 48% of readmissions after laparoscopic bariatric surgery were preventable, indicating a need for quality improvement. 14 Recently, the Centers of Medicare and Medicaid Services have provided financial incentives to decrease readmissions, improve quality of care, and lower costs. [15][16][17] To better understand the effect of preoperative opioid exposure on postoperative readmissions, we used the previously described opioid exposure classifications to study the risk of 30-day hospital readmissions among Medicare beneficiaries 65 years and older undergoing common major or minor surgery.…”

mentioning

confidence: 99%

“…Readmission rates are key quality metrics for stakeholders interested in optimizing the value of surgical care, as preventable readmissions represent missed care opportunities for interventions and the need for better preoperative screening. For example, one study found that 48% of readmissions after laparoscopic bariatric surgery were preventable, indicating a need for quality improvement 14 . Recently, the Centers of Medicare and Medicaid Services have provided financial incentives to decrease readmissions, improve quality of care, and lower costs 15–17 .…”

mentioning

confidence: 99%

Preoperative Opioid Use and Readmissions Following Surgery

Tang

Santosa

Vu³

et al. 2020

Annals of Surgery

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Objective: To assess the association between preoperative opioid exposure and readmissions following common surgery. Summary Background Data: Preoperative opioid use is common, but its effect on opioid-related, pain-related, respiratory-related, and all-cause readmissions following surgery is unknown. Methods: We analyzed claims data from a 20% national Medicare sample of patients ages ! 65 with Medicare Part D claims undergoing surgery between January 1, 2009 and November 30, 2016. We grouped patients by the dose, duration, recency, and continuity of preoperative opioid prescription fills. We used logistic regression to examine the association between prior opioid exposure and 30-day readmissions, adjusted for patient risk factors and procedure type. Results: Of 373,991 patients, 168,579 (45%) filled a preoperative opioid prescription within 12 months of surgery, ranging from minimal to chronic high use. Preoperative opioid exposure was associated with higher rate of opioid-related readmissions, compared with naive patients [low: aOR¼1.63, 95% CI¼1.26-2.12; high: aOR¼3.70, 95% CI¼2.71-5.04]. Preoperative opioid exposure was also associated with higher risk of pain-related readmissions [low: aOR¼1.

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The readmission contradiction: toward clarifying common misconceptions about bariatric readmissions and quality improvement

Cited by 8 publications

References 7 publications

Analysis of Emergency Department Visits and Unplanned Readmission After Bariatric Surgery: An Experience From a Tertiary Referral Center

Analysis of Emergency Department Visits and Unplanned Readmission After Bariatric Surgery: An Experience From a Tertiary Referral Center

Change in Total Body Water as a Metric for Predicting Need for Outpatient Intravenous Fluids in Postoperative Bariatric Patients

Preoperative Opioid Use and Readmissions Following Surgery

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