S. X. Sun2, C. Hollenbeak3, A. Rogers1,2 1Penn State Hershey Medical Center,Minimally Invasive Surgery,Hershey, PA, USA 2Penn State Hershey Medical Center,General Surgery,Hershey, PA, USA 3Penn State Hershey Medical Center,Outcomes Research And Quality,Hershey, PA, USA
Introduction:
Interest is growing in preventing readmissions as payers start to link reimbursement to readmission rates. The purpose of this study was to assess factors that contribute to 30-day readmission rates for patients undergoing gastric bypass for obesity and determine whether these readmissions may be preventable.
Methods:
Data from the Pennsylvania Health Care Cost Containment Council (PHC4) were queried for all patients undergoing elective gastric bypass for obesity in 2011 (n=4,505). The outcomes measured were length of stay (LOS) and 30-day readmission. Univariate comparisons between characteristics of readmitted (n=298) and non-readmitted patients were performed using t tests and chi-square tests. Readmission was modeled using logistic regression; LOS was modeled using linear regression and controlled for potential confounders.
Results:
Of the 298 (6.6%) patients who were readmitted, the most common cause for readmission was bleeding (11.84%) followed by infection (8.88%), and abdominal pain (7.89%). On multivariate analysis, African American race, open gastric bypass, and history of myocardial infarction or rheumatoid arthritis were associated with increased odds of readmission within 30 days of the index hospitalization. Longer LOS was also predictive of readmission (OR 1.10, p=<0.0001). Determinants of LOS were assessed using linear regression. Patients who were above age 51, and those with history of congestive heart failure, peripheral vascular disease, and kidney disease were more likely to have longer lengths of stay. Black race, open surgery, and discharge to an extended care facility were also predictive of prolonged hospital stays.
Conclusion:
This study showed that the most common causes of 30-day readmission following elective gastric bypass was bleeding, infection and abdominal pain. Black race, open surgery and comorbid conditions, such as heart disease, were associated with higher odds of readmission and longer lengths of stay. Even though it is difficult to alter patient comorbidities, our results show that it may be beneficial to optimize these comorbid conditions before gastric bypass surgery as this may lead to lower readmission rates and shorter lengths of stay.