J. L. Salluzzo1, J. Moore2, L. Burke2, K. E. Roberts1, G. Nadzam1, A. J. Duffy1 1Yale University School Of Medicine,Gastrointestinal Surgery,New Haven, CT, USA 2Yale New Haven Hospital,Gastrointestinal Surgery,New Haven, CT, USA
Introduction:
Readmission for dehydration is a common complication of bariatric surgery. Preoperative patient education and postoperative diet plans in bariatric surgery centers emphasize strategies to optimize postoperative oral hydration. Despite this, the Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) national database notes readmission rates for dehydration 1.3% and 1% for Laparoscopic Roux-en-y Gastric Bypass(LRYGB), and 1.7% and 1.3% for Laparoscopic Sleeve Gastrectomy(LSG) for 2013 and 2014, respectively. Dehydration after bariatric surgery is a patient safety issue. In addition to clinical concerns, dehydration and associated inpatient medical costs present a financial burden to hospitals.
We identified dehydration readmissions as a potentially reducible complication in our institution. In 2014, we initiated a quality improvement project to develop an outpatient rehydration protocol at an infusion center.
In addition to standard post-operative follow-up, at-risk patients are identified via routine post-discharge phone calls from bariatric inpatient nurses. The patients are asked screening questions regarding hydration status and oral intake. Patients are then evaluated by bariatric practice APRN. Clinically stable dehydrated patients undergo same day lab work and outpatient fluid resuscitation. A post-infusion evaluation is performed. The patient is followed as an outpatient or admitted to the hospital, as appropriate. We hypothesized that implementation of an outpatient infusion protocol would decrease hospital readmissions related to dehydration in post-bariatric surgical patients.
Methods:
Retrospective review of patients who underwent LSG and LRYGB at an academic teaching hospital in 2013 and 2014 who presented with dehydration. The number of readmissions for dehydration in 2013 (pre protocol) and 2014 (post protocol) was determined, as was the number of patients managed via the infusion center. These data are compared to MBSAQIP national data.
Results:
In 2013, 3.0% of LRYGB (5 of 164) patients and 2.4% of LSG (5 of 212) patients required readmission for dehydration (2.6% overall). After implementation of the infusion center in 2014, 13 patients were identified in screening: 2 were readmitted directly, on protocol, 11 patients were referred for infusions; 7 were managed as outpatients, 4 were readmitted. 0.9% of LRYGB (1 of 110) patients and 1.7% of LSG (5 of 303) patients required readmission (1.45% overall).
Conclusion:
Implementation of a coordinated outpatient rehydration protocol for post-bariatric surgical patients reduced the readmissions at our institution by 40% (44% rate reduction). These rates of readmission compares favorably to national risk-adjusted MBSAQIP benchmarks. We anticipate institutional cost savings from adoption of this protocol.