Reducing Unplanned Readmissions After Colorectal Surgery: The Choice Is the Carrot or the Stick

Stratification of Readmission after Bariatric Surgery by Day of Post-Discharge Presentation

INTRODUCTION/PURPOSE

Reasons of postoperative readmissions may vary based on the timing of rehospitalization. This study characterizes predictors and causes for readmission after bariatric surgery on day-to-day basis after discharge.

MATERIALS AND METHODS

Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data, patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy were identified. Perioperative factors of early readmissions (post-discharge days 0-9) were compared to those of late readmissions (post-discharge days 10-30). Multivariable analysis was conducted to identify predictors of early versus late readmissions. Reasons for readmissions were characterized on day-to-day basis.

RESULTS

Of 509,631 operations, 19,061 (3.7%) cases were readmitted. Of these, 9666 (50.7%) were early, while 9395 (49.3%) were late readmissions. White race (OR = 1.2, CI = [1.1-1.3]), revisional surgery (OR = 1.2, CI = [1.1-1.4]), Roux-en-Y gastric bypass (OR = 1.2, CI = [1.1-1.3]), pulmonary complication (OR = 1.8, CI = [1.5-2.3]), bleeding (OR = 2, CI = [1.6-2.6]), and post-acute care (OR = 1.8, CI = [1.2-2.6]) were predictors of early readmission. Late readmission was associated with body mass index ≥ 40 (CI = 0.83, OR = [0.77-0.89]), renal/urological complication (OR = 0.6, CI = [0.5-0.8]), and deep vein thrombosis (OR = 0.5, CI = [0.4-0.6]). PO intolerance or dehydration/electrolyte imbalance was the most common readmission reason, peaking on post-discharge days 19-30. Pain, medical complications, obstruction, and bleeding were causes of early readmissions. However, venous thromboembolism readmissions peaked after post-discharge day 9.

CONCLUSION

Complex bariatric operations and patients who require post-discharge extended care are associated with early readmissions. Such readmissions are due to early post-discharge complications. However, late readmissions are driven by interrelated risk factors and complications. These findings suggest that targeting patients at risk for delayed rehospitalization is the most efficient approach to minimize readmissions after bariatric surgery.