1
|
Marsall M, Bäuerle A, Hasenberg T, Schräpler L, Robitzsch A, Niedergethmann M, Teufel M, Weigl M. Quality of Care Transition During Hospital Discharge, Patient Safety, and Weight Regain After Bariatric Surgery: a Cross-Sectional Study. Obes Surg 2023; 33:1143-1153. [PMID: 36773181 PMCID: PMC10079752 DOI: 10.1007/s11695-023-06486-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Bariatric surgery is established as the gold standard in the treatment of severe obesity. However, a significant proportion of patients experience a substantial weight regain afterwards. Previous research focused predominantly on patients' personal factors. Yet, critical discharge process factors that contribute to patient's adherence after surgical interventions are rarely examined. This study investigated whether high quality of care transitions in discharge management influences weight regain and the likelihood of experiencing adverse patient safety incidents. MATERIALS AND METHODS A cross-sectional study with 578 patients after bariatric surgery was conducted. Participants answered a standardized assessment on the quality of care transition from hospital to home-, surgery-, and nutrition-related characteristics as well as patient safety incidents. RESULTS Significant weight regain was observed 24 months after surgery. The association between time since surgery and weight regain was weaker in patients with high quality of care transitions (B = 2.27, p < .001). Higher quality of care transition was also significantly related to a lower likelihood of unplanned hospital readmissions (OR = 0.67) and fewer medication complications (OR = 0.48) after surgery. CONCLUSION This study sheds first light on the key influence of high quality of care transitions after bariatric surgery. Improvement efforts into effective discharge processes may establish smoother care transitions and help patients to assume responsibility and compliance with behavioral recommendations after surgery. Moreover, adverse patient safety incidents are less frequent after high quality care transitions indicating both high quality of health services for patients and reducing costs for the health care system.
Collapse
Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127, Bonn, Germany.
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Till Hasenberg
- Helios Obesity Center West, Helios St. Elisabeth Hospital Oberhausen, Witten/Herdecke University, Helios University Hospital Wuppertal, 42283, Wuppertal, Germany
| | - Laura Schräpler
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Anita Robitzsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Marco Niedergethmann
- Department of Surgery, Obesity and Metabolic Surgery Center, Alfried Krupp Hospital Essen, 45131, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127, Bonn, Germany
| |
Collapse
|
2
|
Al-Mazrou AM, Bellorin O, Dhar V, Dakin G, Afaneh C. Selection of Robotic Bariatric Surgery Candidates: a Nationwide Analysis. J Gastrointest Surg 2023; 27:903-913. [PMID: 36737593 DOI: 10.1007/s11605-023-05595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/07/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION This study aims to identify risk factors associated with 30-day major complications, readmission, and delayed discharge for patients undergoing robotic bariatric surgery. METHODS From the metabolic and bariatric surgery and accreditation quality improvement program (2015-2018) datasets, adult patients who underwent elective robotic bariatric operations were included. Predictors for 30-day major complications, readmission, and delayed discharge (hospital stay ≥ 3 days) were identified using univariable and multivariable analyses. RESULTS Major complications in patients undergoing robotic bariatric surgery were associated with both pre-operative and intraoperative factors including pre-existing cardiac morbidity (OR = 1.41, CI = [1.09-1.82]), gastroesophageal reflux disease [GERD] (OR = 1.23, CI = [1.11-1.38]), pulmonary embolism (OR = 1.51, CI = [1.02-2.22]), prior bariatric surgery (OR = 1.66, CI = [1.43-1.94]), increased operating time (OR = 1.003, CI = [1.002-1.004]), gastric bypass or duodenal switch (OR = 1.58, CI = [1.40-1.79]), and intraoperative drain placement (OR = 1.28, CI = [1.11-1.47]). With regard to 30-day readmission, non-white race (OR = 1.25, CI = [1.14-1.39]), preoperative hyperlipidemia (OR = 1.16, CI = [1.14-1.38]), DVT (OR = 1.48, CI = [1.10-1.99]), therapeutic anticoagulation (OR = 1.48, CI = [1.16-1.89]), limited ambulation (OR = 1.33, CI = [1.01-1.74]), and dialysis (OR = 2.14, CI = [1.13-4.09]) were significantly associated factors. Age ≥ 65 (OR = 1.18, CI = [1.04-1.34]), female gender (OR = 1.21, CI = [1.10-1.32]), hypertension (OR = 1.08, CI = [1.01-1.15]), renal insufficiency (OR = 2.32, CI = [1.69-3.17]), COPD (OR = 1.49, CI = [1.23-1.82]), sleep apnea (OR = 1.10, CI = [1.03-1.18]), oxygen dependence (OR = 1.47, CI = [1.10-2.0]), steroid use (OR = 1.26, CI = [1.02-1.55]), IVC filter (OR = 1.52, CI = [1.15-2.0]), and BMI ≥ 40 (OR = 1.12, CI = [1.04-1.21]) were risk factors associated with delayed discharge. CONCLUSION When selecting patients for bariatric surgery, surgeons early in their learning curve for utilizing robotics should avoid individuals with pre-existing cardiac or renal morbidities, venous thromboembolism, and limited functional status. Patients who have had previous bariatric surgery or require technically demanding operations are at higher risk for complications. An evidence-based approach in selecting bariatric candidates may potentially minimize the overall costs associated with adopting the technology.
Collapse
Affiliation(s)
- Ahmed M Al-Mazrou
- Division of GI Metabolic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 525 East 68Th Street Box 294, New York, NY, 10065, USA
| | - Omar Bellorin
- Division of GI Metabolic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 525 East 68Th Street Box 294, New York, NY, 10065, USA
| | - Vikrom Dhar
- Division of GI Metabolic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 525 East 68Th Street Box 294, New York, NY, 10065, USA
| | - Gregory Dakin
- Division of GI Metabolic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 525 East 68Th Street Box 294, New York, NY, 10065, USA
| | - Cheguevara Afaneh
- Division of GI Metabolic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 525 East 68Th Street Box 294, New York, NY, 10065, USA.
| |
Collapse
|
3
|
A Cost Analysis of Healthcare Episodes Including Day-Case Bariatric Surgery (Roux-en-Y Gastric Bypass and Sleeve Gastrectomy) Versus Inpatient Surgery. Obes Surg 2022; 32:2504-2511. [PMID: 35689142 DOI: 10.1007/s11695-022-06144-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Assessing the medico-economic outcomes of a healthcare pathway including day-case bariatric surgery versus the conventional pathway. METHODS This economical evaluation is a prospective cohort study with historical controls. Between March 2019 and December 2020, 30 patients eligible for bariatric surgery were considered in the day-case group. Surgical procedures included sleeve gastrectomy and Roux-en-Y gastric bypass. The day-case pathway included patient education, post-discharge follow-up by a community nurse twice-daily and standardized communications to surgeons. Day-case patients were paired with 30 inpatients, based on the type of intervention, age, and ASA status. The primary outcome was the cost of care episodes from the preoperative visit to the 30-day postoperative visit. Micro-costing methodology and activity-based costing were used. Secondary outcomes included length of hospital stay, rate of unanticipated events, and patient' satisfaction assessment. RESULTS Male-to-female ratio was 1/2. In the day-case versus inpatient group, age, number of associated medical conditions, and BMI (42.9 ± 4.9 versus 42.6 ± 4.6, p > 0.05) were similar. In the day-case group, there were 7 overnight stays (23.3%), 3 readmissions (10%), and 4 unscheduled consultations (13.3%). The overall length of hospital stay was significantly shorter (0.65 ± 0.33, versus 2.9 ± 0.4 days, p < 0.0001). The complication rate was 6.6% in both groups. The cost of the care episode was € 4272.9 ± 589.7 for the day-case group versus € 4993.7 ± 695.6 for inpatients, corresponding to a 14.4% cost reduction (p = 0.0254). CONCLUSIONS Day-case bariatric surgery appears to be safe and beneficial in terms of costs. It involves a specific organization with postdischarge follow-up. TRIAL REGISTRATION ClinicalTrial.gov: NCT04423575.
Collapse
|
4
|
O'Neill SM, Needleman B, Narula V, Brethauer S, Noria SF. An analysis of readmission trends by urgency and race/ethnicity in the MBSAQIP registry, 2015-2018. Surg Obes Relat Dis 2021; 18:11-20. [PMID: 34789421 DOI: 10.1016/j.soard.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/23/2021] [Accepted: 10/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Large-scale analyses stratifying bariatric surgery readmissions by urgency are lacking. OBJECTIVES Identify predictors of urgent/nonurgent readmission among "ideal" bariatric candidates, using a national registry. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database. METHODS We extracted an "ideal" patient cohort from the 2015-2018 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) registry, characterized by only typical weight-related comorbidities (hypertension [HTN], obstructive sleep apnea [OSA], gastroesophageal reflux disease [GERD], and diabetes (insulin-dependent diabetes mellitus [IDDM] and non-insulin-dependent diabetes mellitus [NIDDM]) undergoing primary bariatric surgery with an uneventful postoperative course. Readmissions were classified as "urgent" (UR; e.g., leak, obstruction, bleeding) or "nonurgent" (NUR; e.g., dehydration, nonspecific abdominal pain). χ2 or t test analyses were used for bivariate significance testing. Multivariate logistic regression models were constructed to assess independent predictors of readmission. RESULTS The cohort (N = 292,547) comprised 38.5% of all MBSAQIP patients (mean age [standard deviation] = 43.2 [11.7]; body mass index [BMI] = 44.9 [6.6]; 81% female; 62% White, 17% Black, 14% Hispanic). Total readmission rates were 2.75% (n = 8046) and decreased from 2015-2018 (3.00%-2.63%; P < .001). Independent predictors of readmissions included Roux-en-Y gastric bypass (RYGB) (odds ratio [OR] = 1.97, p < .001), Black (OR = 1.46, P < .001) and Hispanic race (OR = 1.14, P < .001), GERD (OR = 1.27, P < .001), HTN (OR = 1.08, P = .003), and IDDM (OR = 1.39, P < .001). NUR and UR readmission rates were 1.27% (n = 3702) and 1.06% (n = 3090), respectively. NURs decreased over time (1.42%-1.16%, P < .001), with no change in Urs (1.01%-1.06%, P = .51); this trend persisted in multivariate analysis (2017: NUR OR = .85, P < .001; 2018: NUR OR = .82, p < .001). Independent predictors of both URs and NURs included Black (NUR OR = 1.71, p < .001; UR OR = 1.27, p < .001) and Hispanic (NUR OR = 1.15, P < .001; UR OR = 1.19, P < .001) race, RYGB (NUR OR = 1.84, P < .001; UR OR = 2.34, P < .001), and GERD (NUR OR = 1.39, p < .001; UR OR = 1.17, P < .001). Female sex (NUR OR = 1.64, P < .001), age (NUR OR = .98, P < .001), HTN (NUR OR = 1.22, P < .001), and IDDM (NUR OR = 1.41, P < .001) predicted NURs, while higher BMI (UR OR = 1.01, P < .001), and OSA (UR OR = 1.10, P = .02) predicted URs. CONCLUSION Readmission rates for "ideal" bariatric patients improved over time, driven by reductions in non-urgent etiologies. Racial disparities persist for both urgent and non-urgent causes of readmission.
Collapse
Affiliation(s)
- Sean M O'Neill
- The Ohio State Wexner Medical Center, Division of General and Gastrointestinal Surgery, Columbus, Ohio
| | - Bradley Needleman
- The Ohio State Wexner Medical Center, Division of General and Gastrointestinal Surgery, Columbus, Ohio
| | - Vimal Narula
- The Ohio State Wexner Medical Center, Division of General and Gastrointestinal Surgery, Columbus, Ohio
| | - Stacy Brethauer
- The Ohio State Wexner Medical Center, Division of General and Gastrointestinal Surgery, Columbus, Ohio
| | - Sabrena F Noria
- The Ohio State Wexner Medical Center, Division of General and Gastrointestinal Surgery, Columbus, Ohio.
| |
Collapse
|
5
|
Vitiello A, Berardi G, Velotti N, Schiavone V, Musella M. Learning curve and global benchmark values of laparoscopic sleeve gastrectomy: results of first 100 cases of a newly trained surgeon in an Italian center of excellence. Updates Surg 2021; 73:1891-1898. [PMID: 34189700 PMCID: PMC8500908 DOI: 10.1007/s13304-021-01121-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/20/2021] [Indexed: 12/12/2022]
Abstract
To evaluate whether the learning curve for sleeve gastrectomy could be completed after 50 cases. First 100 patients undergoing LSG under a newly trained laparoscopic surgeon were included in this study and divided into two groups of 50 consecutive patients each. Perioperative outcomes were compared to recently introduced global benchmarks. Short-term weight loss was calculated as Total Weight Loss Percent (%TWL) and complications were classified in accordance with the Clavien–Dindo classification. CUSUM analysis was performed for operative time and hospital stay. Mean preoperative age and BMI were 41.8 ± 10.3 years and 42.9 ± 5.4 kg/m2, respectively. Demographics and rate of patients with previous surgery were comparable preoperatively in the two groups. Mean operative time was 92.1 ± 19.3 min and hospital stay was 3.4 ± 0.6 days as per our standard protocol of discharge. Uneventful postoperative course was recorded in 93% of patients and only one case of staple line leak was registered in the first 50 cases (group 1). No statistical difference in BMI and %TWL was found between the two groups at any time of follow-up. Comparison between two groups showed a significant reduction in hospital stay and operative time after the first 50 LSGs (p < 0.05). LSG can be performed by newly trained surgeons proctored by senior tutors. At least 50 cases are needed to meet global benchmark cut-offs and few more cases may be required to reach the plateau of the learning curve.
Collapse
Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Vincenzo Schiavone
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| |
Collapse
|
6
|
Jalilvand A, Levene KA, Shah K, Needleman B, Noria SF. Characterization of urgent versus nonurgent early readmissions (<30 days) following primary bariatric surgery: a single-institution experience. Surg Obes Relat Dis 2021; 17:921-930. [PMID: 33715991 DOI: 10.1016/j.soard.2021.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Studies on early postoperative readmissions after bariatric surgery (BS) have examined readmissions as a single entity, regardless of urgency. Strategies to lower nonurgent readmissions would reduce unnecessary hospital utilization. OBJECTIVES To identify predictors of urgent readmissions (UR) versus nonurgent readmissions (NUR) at 30 days post-BS. SETTING Single academic institution. METHODS Patients undergoing primary BS over 2 years (n = 589) were retrospectively reviewed. Baseline demographic, medical, and hospitalization data were compared between readmitted patients, stratified by urgency, and nonreadmitted patients. Multivariate regression models of UR and NUR were created using variables with a P value ≤ .2 on univariate analyses. A P value ≤ .05 was considered statistically significant. RESULTS There were 39 documented instances of 30-day readmissions, of which 44% (n = 17) were NUR; NUR patients were more likely to be female (100% versus 78.2% male; P = .03) and trended toward being younger, experiencing ≥2 perioperative complications, and having a longer index hospital length of stay (LOS). Patients with URs had a higher baseline BMI (52.5 ± 11.4 kg/m2 versus 48.7 ± 8.3 kg/m2, respectively; P = .04), were more likely to have sleep apnea (77.3% versus 56.1%, respectively; P = .05), had a longer LOS (3 versus 2 d, respectively; P = .007), and were more likely to have ≥2 postoperative complications (46% versus 17.0%, respectively; P = .003) compared with those with an NUR. Independent predictors of NUR included public insurance (odds ratio [OR] = 3.7; 95% confidence interval [CI], 1.17-11.67; P = .03), younger age (OR = 1.05; 95% CI, 1-1.01; P = .04), and female sex, while URs were independently predicted by LOS (OR = 1.3; 95% CI, 1.04-1.5; P = .02). CONCLUSIONS Public insurance appears to be associated with NURs, while LOS predicts URs after BS. This suggests an important dichotomy within readmissions based on urgency, which has important implications for targeted quality initiatives.
Collapse
Affiliation(s)
- Anahita Jalilvand
- Division of General and Gastrointestinal Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Katelyn A Levene
- Division of General and Gastrointestinal Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Kejal Shah
- Division of General and Gastrointestinal Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Bradley Needleman
- Division of General and Gastrointestinal Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Sabrena F Noria
- Division of General and Gastrointestinal Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio.
| |
Collapse
|