Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., SPC 5362, Ann Arbor, MI, 48109-5362, USA.
Surg Endosc. 2021 Jan;35(1):291-297. doi: 10.1007/s00464-020-07395-w. Epub 2020 Feb 6.
The care of patients who have undergone bariatric surgery is complex and requires a multidisciplinary approach. As such, these patients may be prone to fragmentation of care and differences in healthcare outcomes. We aimed to (1) determine the incidence of fragmentation among patients after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG), (2) identify risk factors for readmission, and (3) ascertain whether care fragmentation affects outcomes.
This is a retrospective cohort study using the National Readmission Database 2016. Patients were included if they had primary bariatric surgery during the index hospitalization using appropriate ICD-10 CM codes. Fragmentation of care was defined as a readmission to a different hospital within 90 days of the index admission. Primary outcome was incidence of fragmentation. Secondary outcomes were impact of fragmentation on (1) in-hospital mortality; (2) resource utilization (length of stay (LOS), total hospitalization charges and costs, in-hospital upper endoscopy (EGD), and abdominal imaging studies; and (3) independent predictors of readmission using multivariate regression analysis.
A total of 136,536 subjects were included. 90-day readmission demonstrated a prevalence of fragmentation of 21.1%. Type of surgery was an independent predictor of fragmentation, with RYGB leading to increased risk (OR 1.90 [95% confidence interval (CI) 1.61, 2.25]; p-value < 0.0001). RYGB was associated with higher adjusted mean hospitalization costs, which was not explained by increased EGD (OR 0.95, CI 0.68, 1.32) or abdominal imaging (OR 0.52, CI 0.25, 1.06). No differences were found in mortality or LOS.
Over 20% of patients following primary bariatric surgery have inpatient readmissions that are fragmented, driven by patients who have undergone RYGB surgery. This may be due to the complexity of this procedure and the need for a multispecialty approach. Additional efforts targeting fragmentation should be made to better coordinate the management of these complex patients and reduce healthcare costs.
接受减重手术的患者的护理非常复杂，需要多学科方法。因此，这些患者可能容易出现护理碎片化和医疗保健结果的差异。我们旨在：（1）确定 Roux-en-Y 胃旁路术（RYGB）或袖状胃切除术（SG）后患者的碎片化发生率；（2）确定再入院的危险因素；（3）确定护理碎片化是否会影响结果。
这是一项使用 2016 年全国再入院数据库的回顾性队列研究。如果患者在索引住院期间使用适当的 ICD-10 CM 代码进行主要减重手术，则将其纳入研究。护理碎片化的定义是在索引入院后 90 天内到不同医院再次入院。主要结局是碎片化的发生率。次要结局是碎片化对（1）住院死亡率的影响；（2）资源利用（住院时间（LOS）、总住院费用和成本、住院上消化道内镜检查（EGD）和腹部影像学研究；（3）使用多变量回归分析确定再入院的独立预测因素。
共纳入 136536 例患者。90 天再入院的碎片化发生率为 21.1%。手术类型是碎片化的独立预测因素，RYGB 导致风险增加（OR 1.90 [95%置信区间（CI）1.61，2.25]；p 值<0.0001）。RYGB 与调整后平均住院费用较高相关，这不能用增加 EGD（OR 0.95，CI 0.68，1.32）或腹部影像学（OR 0.52，CI 0.25，1.06）来解释。死亡率或 LOS 无差异。
超过 20%接受主要减重手术的患者有住院再入院，这是碎片化的，由接受 RYGB 手术的患者驱动。这可能是由于该手术的复杂性和多学科方法的需要。应针对碎片化做出更多努力，以更好地协调这些复杂患者的管理并降低医疗保健成本。
