Analysis of bariatric surgical complications requiring interhospital transfers using a modified Victorian Audit of Surgical Mortality framework.

Abstract

Surgical audit is key in upholding the standards of surgical care but may be inadequate in capturing morbidity experienced by patients being transferred across different health systems. The aim of this study was to assess the utility of an objective framework in the evaluation of clinical issues surrounding interhospital transfers (IHTs). A retrospective cohort study was conducted at a Victorian state bariatric hospital. Patients transferred with bariatric surgery related complications between 2014 and 2021 were included. Each case was reviewed by two surgeons using an objective framework developed via a modified Delphi-process. Key issues and preventability surrounding each transfer were evaluated. Inter-observer agreement was assessed using weighted Cohen's Kappa coefficient. Seventy-three patients were included. The most common indication for transfer was proximal staple line leak post sleeve gastrectomy (34/73, 46.6%). Length of stay was 38.3 ± 58.8 days. Cost of care amounted to AUD $110 666.18 per patient. Delay in transfer and complication recognition were present in 20% of cases (Cohen's Kappa 0.51;0.61). Human factors and patient related factors were the most common principal underlying causes (Cohen's Kappa 0.59). A third of the complications (n = 25/73, 34.2%), were potentially preventable (Cohen's Kappa 0.58) and more than half (39/73, 53.4%) did not have documented objective feedback to referring clinicians. IHTs associated with bariatric surgery complications have significant morbidity and costs. A structured framework in reviewing IHT can consistently identify potentially modifiable factors that improve clinical outcomes, and constructive feedback to the referring clinician should be actively facilitated and documented.