Postoperative Care Fragmentation Is Associated with Increased 30-Day Mortality after Bariatric Surgery

Abstract

Compromised access following bariatric centers-or-excellence designations may have led to increased incidence of non-index readmissions and worsened care fragmentation. We seek to evaluate risk factors and impact of non-index readmissions on short-term mortality during readmission using a national bariatric registry data from 2015. A retrospective cohort study was performed using a national clinical database. Multivariate logistic regression models were developed to quantify association between non-index readmissions and 30-day mortality among bariatric patients with 30-day readmissions. A total of 4704 patients were identified as undergoing bariatric surgery and readmitted within 30days. Of these, 325 (6.9%) patients were readmitted to a non-index facility while the rest were hospitalized at the original hospital. Patient characteristics were largely similar between the two comparison groups, although patients with in-hospital complications and non-home disposition during the initial stay were more likely to experience non-index readmissions. Multivariate regression demonstrated that non-index readmission was associated with an adjusted odds ratio of 4.4 for 30-day mortality (95% confidence interval 2.6-9.2, p < 0.01). The most common reason for mortality for both index and non-index readmissions was pulmonary embolism. Care fragmentation may lead to increased 30-day mortality during readmissions following bariatric surgery. Heightened vigilance and longitudinal follow-up planning is recommended for patients with elevated risk for venous thromboembolism.