Institute for Patient Safety (IfPS), University Hospital Bonn, 53127, Bonn, Germany.
Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany.
Obes Surg. 2023 Apr;33(4):1143-1153. doi: 10.1007/s11695-023-06486-6. Epub 2023 Feb 11.
Bariatric surgery is established as the gold standard in the treatment of severe obesity. However, a significant proportion of patients experience a substantial weight regain afterwards. Previous research focused predominantly on patients' personal factors. Yet, critical discharge process factors that contribute to patient's adherence after surgical interventions are rarely examined. This study investigated whether high quality of care transitions in discharge management influences weight regain and the likelihood of experiencing adverse patient safety incidents.
A cross-sectional study with 578 patients after bariatric surgery was conducted. Participants answered a standardized assessment on the quality of care transition from hospital to home-, surgery-, and nutrition-related characteristics as well as patient safety incidents.
Significant weight regain was observed 24 months after surgery. The association between time since surgery and weight regain was weaker in patients with high quality of care transitions (B = 2.27, p < .001). Higher quality of care transition was also significantly related to a lower likelihood of unplanned hospital readmissions (OR = 0.67) and fewer medication complications (OR = 0.48) after surgery.
This study sheds first light on the key influence of high quality of care transitions after bariatric surgery. Improvement efforts into effective discharge processes may establish smoother care transitions and help patients to assume responsibility and compliance with behavioral recommendations after surgery. Moreover, adverse patient safety incidents are less frequent after high quality care transitions indicating both high quality of health services for patients and reducing costs for the health care system.
减重手术已被确立为治疗重度肥胖的金标准。然而，相当一部分患者在术后会出现明显的体重反弹。先前的研究主要集中在患者的个人因素上。然而，很少有研究关注影响患者术后依从性的关键出院流程因素。本研究调查了出院管理中高质量的护理交接是否会影响体重反弹和发生不良患者安全事件的可能性。
对 578 名接受过减重手术后的患者进行了一项横断面研究。参与者回答了一份关于从医院到家庭、手术和营养相关特征以及患者安全事件的护理交接质量的标准化评估。
术后 24 个月观察到明显的体重反弹。在护理交接质量高的患者中，手术时间与体重反弹之间的关联较弱（B=2.27，p<.001）。高质量的护理交接也与术后无计划再次住院（OR=0.67）和更少的药物并发症（OR=0.48）的可能性较低显著相关。
本研究首次阐明了减重手术后高质量护理交接的关键影响。改善有效的出院流程的努力可能会建立更顺畅的护理交接，并帮助患者在术后承担责任并遵守行为建议。此外，高质量的护理交接后发生不良患者安全事件的频率较低，这表明患者获得了高质量的医疗服务，并降低了医疗保健系统的成本。
