Evaluating organizational factors associated with postoperative bariatric surgery readmissions

Abstract

Background: Several patient and surgical characteristics have been identified as risk factors for readmission after bariatric surgery, but there is a paucity of information on how organizational factors influence this metric.

Objective: To evaluate the association between readmissions and several organizational factors, including compliance with best practices to reduce unplanned hospital visits, major complication rates, and the emergency department-sourced readmission (EDSR) rate.

Methods: The Michigan Bariatric Surgery Collaborative database was used to identify patients undergoing primary bariatric procedures. Using an indirect standardization process, each site's observed-to-expected ratio for 30-day readmissions was calculated. The association between each site's adjusted readmission rate and each organizational factor was calculated with Pearson correlation coefficients.

Results: There was significant variation among the sites' adjusted rates of readmission, EDSR, best practice compliance rates, and major complication rates. There was a moderate association between each site's adjusted readmission rate and the rate of EDSR (r = .53) and major complications (r = .53). However, the association between bariatric centers' compliance with best practices to reduce unplanned hospital visits and readmission rates was fairly weak (r = -.14).

Conclusion: Bariatric centers with higher rates of major complications and sites with emergency departments that are less likely to treat and discharge patients are more likely to have higher readmission rates. Even though compliance with best practices to reduce readmissions may be important, results suggest that it does not significantly influence the readmission rates at sites that perform only these basic measures or perform them inadequately.

Keywords: Bariatric surgery; Emergency department characteristics; Postoperative complications; Readmissions.