Incidence of and risk factors associated with care fragmentation following bariatric surgery

Joseph K Canner; Sarah R Kaslow; Faiz Gani; Hatim A AlSulaim; Gregory P Prokopowicz; Selma Pourzal; Kimberley E Steele

doi:10.1016/j.soard.2019.03.035

Incidence of and risk factors associated with care fragmentation following bariatric surgery

Surg Obes Relat Dis. 2019 Jul;15(7):1170-1181. doi: 10.1016/j.soard.2019.03.035. Epub 2019 Mar 23.

Authors

Joseph K Canner¹, Sarah R Kaslow², Faiz Gani³, Hatim A AlSulaim⁴, Gregory P Prokopowicz⁵, Selma Pourzal⁶, Kimberley E Steele⁷

Affiliations

¹ Department of Surgery, Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: jcanner1@jhmi.edu.
² Department of Surgery, Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Baltimore, Maryland.
³ Department of Surgery, Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁴ Department of Surgery, Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Surgery, Unaizah College of Medicine, Qassim University, Qassim, Saudi Arabia.
⁵ Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁶ Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
⁷ Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

PMID: 31147280
DOI: 10.1016/j.soard.2019.03.035

Abstract

Background: Current readmission rates do not account for readmissions to nonindex hospitals and may underestimate the actual burden of readmissions.

Objective: Using a nationally representative database, we sought to characterize nonindex readmissions following bariatric surgery and identify risk factors associated with readmission to a nonindex hospital.

Setting: Patients in the United States undergoing elective bariatric surgery.

Methods: The Nationwide Readmissions Database was used to identify a weighted sample of 545,377 patients undergoing elective bariatric surgery between 2010 and 2014. Multivariable logistic regression analysis was used to identify factors associated with readmission to a nonindex hospital.

Results: Among all patients, 5.6% were readmitted at least once within 30 days. Within the subgroup of patients who were readmitted, 17.6% were readmitted to a different hospital than the index admission hospital. Factors independently associated with higher odds of readmission to a nonindex hospital were primary payor (Medicare: odds ratio [OR] = 1.48, 95% confidence interval [CI]: 1.24-1.75; Medicaid: OR = 1.56, 95% CI: 1.26-1.95), All Patients Refined Diagnosis Related Group severity of illness score (extreme versus minor: OR = 1.48; 95% CI: 1.04-2.09), primary procedure (laparoscopic sleeve gastrectomy versus laparoscopic gastric bypass: OR = 1.23; 95% CI: 1.05-1.44), hospital bed size (reference: small hospital, medium: OR = .52, 95% CI: .39-.70; large: OR = .47, 95% CI: .35-.63), hospital ownership (reference: private, nonprofit hospital, government: OR = 1.77, 95% CI: 1.32-2.37; private, investor-owned: OR = 1.33, 95% CI: 1.07-1.64), and hospital location (reference: metropolitan area >1 million population, metropolitan <1 million population: OR = .44, 95% CI: .34-.56; micropolitan/rural: OR = .44, 95% CI: .27-.73).

Conclusion: Failure to account for readmissions to different hospitals may underestimate readmission rates by approximately 18%.

Keywords: Bariatric surgery; Care fragmentation; Nonindex readmission; Readmission.

MeSH terms

Adult
Bariatric Surgery / adverse effects*
Female
Humans
Incidence
Male
Middle Aged
Obesity, Morbid / surgery*
Patient Readmission / statistics & numerical data*
Postoperative Complications / epidemiology*
Risk Factors
Socioeconomic Factors
United States