Yen-Yi Juo1,2, Usah Khrucharoen1,2, Yas Sanaiha1, Yijun Chen1,3, Erik Dutson4,5,6,7. 1. Center for Advanced Surgical and Interventional Technology (CASIT), University of California Los Angeles, Los Angeles, CA, USA. 2. Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA. 3. Center for Obesity and METabolic Health (COMET), University of California Los Angeles (UCLA), Los Angeles, CA, USA. 4. Center for Advanced Surgical and Interventional Technology (CASIT), University of California Los Angeles, Los Angeles, CA, USA. edutson@mednet.ucla.edu. 5. Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA. edutson@mednet.ucla.edu. 6. Center for Obesity and METabolic Health (COMET), University of California Los Angeles (UCLA), Los Angeles, CA, USA. edutson@mednet.ucla.edu. 7. Department of Surgery, Division of General Surgery, David Geffen School of Medicine at UCLA, Box 956904, 72-251 Center for Health Sciences, Los Angeles, CA, 90095-6904, USA. edutson@mednet.ucla.edu.
Abstract
BACKGROUND: Compromised access following bariatric centers-or-excellence designations may have led to increased incidence of non-index readmissions and worsened care fragmentation. We seek to evaluate risk factors and impact of non-index readmissions on short-term mortality during readmission using a national bariatric registry data from 2015. METHODS: A retrospective cohort study was performed using a national clinical database. Multivariate logistic regression models were developed to quantify association between non-index readmissions and 30-day mortality among bariatric patients with 30-day readmissions. RESULTS: A total of 4704 patients were identified as undergoing bariatric surgery and readmitted within 30 days. Of these, 325 (6.9%) patients were readmitted to a non-index facility while the rest were hospitalized at the original hospital. Patient characteristics were largely similar between the two comparison groups, although patients with in-hospital complications and non-home disposition during the initial stay were more likely to experience non-index readmissions. Multivariate regression demonstrated that non-index readmission was associated with an adjusted odds ratio of 4.4 for 30-day mortality (95% confidence interval 2.6-9.2, p < 0.01). The most common reason for mortality for both index and non-index readmissions was pulmonary embolism. CONCLUSIONS: Care fragmentation may lead to increased 30-day mortality during readmissions following bariatric surgery. Heightened vigilance and longitudinal follow-up planning is recommended for patients with elevated risk for venous thromboembolism.
BACKGROUND: Compromised access following bariatric centers-or-excellence designations may have led to increased incidence of non-index readmissions and worsened care fragmentation. We seek to evaluate risk factors and impact of non-index readmissions on short-term mortality during readmission using a national bariatric registry data from 2015. METHODS: A retrospective cohort study was performed using a national clinical database. Multivariate logistic regression models were developed to quantify association between non-index readmissions and 30-day mortality among bariatric patients with 30-day readmissions. RESULTS: A total of 4704 patients were identified as undergoing bariatric surgery and readmitted within 30 days. Of these, 325 (6.9%) patients were readmitted to a non-index facility while the rest were hospitalized at the original hospital. Patient characteristics were largely similar between the two comparison groups, although patients with in-hospital complications and non-home disposition during the initial stay were more likely to experience non-index readmissions. Multivariate regression demonstrated that non-index readmission was associated with an adjusted odds ratio of 4.4 for 30-day mortality (95% confidence interval 2.6-9.2, p < 0.01). The most common reason for mortality for both index and non-index readmissions was pulmonary embolism. CONCLUSIONS: Care fragmentation may lead to increased 30-day mortality during readmissions following bariatric surgery. Heightened vigilance and longitudinal follow-up planning is recommended for patients with elevated risk for venous thromboembolism.
Entities:
Keywords:
Access disparity; Bariatric surgery; Care fragmentation; Pulmonary embolism
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