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Impact of fragmentation on rehospitalization after bariatric surgery

机译：乳腺手术后碎片对再生的影响

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Background 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. Methods 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. Results 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. Conclusions 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.
机译：背景：接受减肥手术的患者的护理是复杂的，需要多学科的方法。因此，这些患者可能容易出现护理碎片化和医疗结果差异。我们的目的是（1）确定Roux-en-Y胃分流术（RYGB）或袖状胃切除术（SG）后患者碎片化的发生率，（2）确定再次入院的风险因素，以及（3）确定护理碎片化是否影响预后。方法采用2016年国家再入院数据库进行回顾性队列研究。如果患者在指数住院期间使用适当的ICD-10 CM代码进行了原发性减肥手术，则纳入患者。治疗碎片化被定义为在指数入院后90天内再次入院到其他医院。主要结果是碎片的发生率。次要结果是碎片化对（1）住院死亡率的影响；（2） 资源利用率（住院时间（LOS）、总住院费用和成本、院内上消化道镜检查（EGD）和腹部成像研究；（3）采用多元回归分析的再入院独立预测因素。结果共纳入136536名受试者。再入院90天，碎片化患病率为21.1%。手术类型是碎片化的独立预测因素，RYGB导致风险增加（或1.90[95%可信区间（CI）1.61,2.25]；p值<0.0001）。RYGB与更高的调整后平均住院费用相关，这不能用EGD增加（OR 0.95，CI 0.68,1.32）或腹部成像（OR 0.52，CI 0.25,1.06）来解释。死亡率和服务水平没有差异。结论超过20%的原发性减肥手术后患者的再入院率是零散的，这是由接受过RYGB手术的患者驱动的。这可能是由于这一过程的复杂性和对多专业方法的需要。应做出更多针对碎片化的努力，以更好地协调这些复杂患者的管理，并降低医疗成本。

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