Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France.
INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Université Paris Descartes, F-75006, Paris, France.
Obes Surg. 2019 Nov;29(11):3680-3689. doi: 10.1007/s11695-019-04053-6.
Readmission rate is considered an indicator of quality of care, which is already used in some countries to impose financial penalties on hospital with readmissions in excess of the national average. Nevertheless, this indicator presents some controversial drawbacks. The objective of this study was the assessment of readmission rate after bariatric surgery.
This is a retrospective observational study on a national administrative claims database, the Information Systems Medicalization Program, PMSI, which is a nationwide billing tool collecting information on all hospital discharges in France. All adult patients operated of bariatric surgery from January 1, 2013, through December 31, 2016, were included. The main outcome was unplanned 30-day readmission rate. Secondary outcome was the analysis of reasons for readmission.
During the study period, out of 187,000 bariatric interventions, the unplanned readmission rate was 4.7%. A significant difference was found between bariatric procedures (gastric banding 3.1%, sleeve gastrectomy 4.5%, gastric bypass 5.7%, p < 0.001). The most important risk factors are the Charlson comorbidity index, the occurrence of a complication after the initial intervention, and the bariatric technique type itself. The main causes of return to the hospital are abdominal pain, peritonitis, nausea/vomiting, and bleeding. After adjustment for confounders, the rate of rehospitalization varies between 1.0% and 16.0% among all French hospitals.
Approximately 5 % of patients undergoing bariatric surgery suffered a readmission within 30 days. We identified common causes and identified patients at high risk for such an event. These information could be useful for developing strategies to improve in- and outpatient care in bariatric population.
再入院率被认为是医疗质量的一个指标，在一些国家已经被用来对再入院率超过全国平均水平的医院进行经济处罚。然而，这一指标存在一些有争议的缺陷。本研究的目的是评估减肥手术后的再入院率。
这是一项基于国家行政索赔数据库的回顾性观察研究，即医疗信息系统计划（PMSI），这是一个全国性的计费工具，收集法国所有医院出院患者的信息。所有于 2013 年 1 月 1 日至 2016 年 12 月 31 日接受减肥手术的成年患者均纳入研究。主要结局是 30 天内非计划性再入院率。次要结局是对再入院原因的分析。
在研究期间，187000 例减肥手术中，非计划性再入院率为 4.7%。不同减肥手术方式之间存在显著差异（胃带术 3.1%，胃袖状切除术 4.5%，胃旁路术 5.7%，p<0.001）。最重要的风险因素是 Charlson 合并症指数、初始干预后并发症的发生以及减肥技术类型本身。患者返回医院的主要原因是腹痛、腹膜炎、恶心/呕吐和出血。在调整混杂因素后，所有法国医院的再住院率在 1.0%至 16.0%之间不等。
大约 5%接受减肥手术的患者在 30 天内再次入院。我们确定了常见的原因，并确定了发生这种事件的高危患者。这些信息可能有助于制定改善减肥患者门诊和住院护理的策略。
