Macht Ryan, Cassidy Ruth, Cabral Howard, Kazis Lewis E, Ghaferi Amir
Department of Surgery, Boston Medical Center, Boston, Massachusetts.
Michigan Bariatric Surgery Collaborative, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
Surg Obes Relat Dis. 2017 Jun;13(6):1004-1009. doi: 10.1016/j.soard.2016.12.029. Epub 2017 Jan 2.
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.
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.
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.
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).
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.
多项患者和手术特征已被确定为减肥手术后再入院的风险因素，但关于组织因素如何影响这一指标的信息却很少。
评估再入院与若干组织因素之间的关联，包括遵守减少非计划住院就诊的最佳实践、主要并发症发生率以及急诊科导致的再入院（EDSR）率。
利用密歇根减肥手术协作数据库确定接受初次减肥手术的患者。通过间接标准化过程，计算每个机构30天再入院的观察值与预期值之比。用Pearson相关系数计算每个机构调整后的再入院率与每个组织因素之间的关联。
各机构调整后的再入院率、EDSR率、最佳实践遵守率和主要并发症发生率存在显著差异。每个机构调整后的再入院率与EDSR率（r = 0.53）和主要并发症发生率（r = 0.53）之间存在中度关联。然而，减肥中心遵守减少非计划住院就诊的最佳实践与再入院率之间的关联相当弱（r = -0.14）。
主要并发症发生率较高的减肥中心以及急诊科治疗和出院患者可能性较小的机构，再入院率更有可能较高。尽管遵守减少再入院的最佳实践可能很重要，但结果表明，这对仅采取这些基本措施或执行不力的机构的再入院率没有显著影响。
