K. Levene1, M. Bai2, A. Suzo1, R. Dettorre1, B. Needleman1, S. Noria1 1Ohio State University,Division Of General And Gastrointestinal Surgery,Columbus, OH, USA 2Ohio State University,College Of Medicine,Columbus, OH, USA
Introduction: Readmission rates are a performance metric in the Pay for Performance model, implemented by the Centers for Medicare and Medicaid Services, which have an effect on hospital reimbursement and hospital ranking. Hospital readmissions, during the early postoperative period after bariatric surgery, range from 5% – 20%, and are predominantly related to poor pain control, nausea, vomiting, dehydration and wound infections. Based on this, we sought to characterize factors related to readmission at our institution to identify actionable targets to reduce rates.
Methods: A retrospective review was conducted on patients who underwent primary Roux-en-y gastric bypass (RYGB) and sleeve gastrectomy (SG) at The Ohio State University from July 2014 to February 2016. We included all patients treated according to our standard Care Coaching model throughout their index admission and subsequently readmitted prior to their first postoperative clinic visit. Variables reviewed included age, gender, ethnicity, co-morbidities, BMI, hospital length of stay, days to readmission, cause for readmission, number of readmissions, postoperative BMI, and insurance status.
Results: From July 2014 to February 2016, 477 patients underwent primary RNYGB or SG. Of these patients, 32 (6.7%) were readmitted (53% RYGB, 47% SG). Within the readmitted cohort, 84% were female, and 78% were Caucasian. Average age and BMI was 41.7 years, and 47.47 kg/m2, respectively. The average length of stay for the index admission was 2.9 ± 1.1 days. The time to readmission was 6.56 ± 4.8 days. Of note, 41% of readmitted patients were covered by Medicaid/Medicare, while 59% had commercial insurance. No self-pay patients were readmitted. Interestingly, breakdown of insurance coverage for patients who undergo surgery demonstrated 14.5% Medicare/Medicaid, 83.2% commercial insurance and 2.3% self-pay. Primary complications leading to readmissions included, nausea/vomiting/dehydration (28%), pain (22%), and surgical site infection (19%). Nine percent of readmitted patients were readmitted a second time.
Conclusion: At our institution, rates for primary RYGB and SG fall within the national average. However, despite the implementation of the OSU Care Coaching model, our standardized post-operative care pathway, the readmission rate for Medicare/Medicaid beneficiaries is high given they comprise only 14.5% of the total number of patients having surgery. Therefore, future endeavors will include a more in-depth analysis of our Medicare/Medicaid beneficiaries to assess the gaps in care which, in turn, will be integrated into a program of individualized pre- and post-operative preparation with clear recovery expectations. Ultimately, integration of a care-navigator for Medicare/Medicaid beneficiaries may help overcome obstacles to recovery and decrease readmission rates in this patient population.