title: Risk factors for 30-day readmissions and modifying postoperative care after gastric bypass surgery.
abstract: BACKGROUND
  Although hospital 30-day readmissions policies currently focus on medical conditions, readmission penalties will be expanding to encompass surgical procedures, logically beginning with common and standardized procedures, such as gastric bypass. Therefore, understanding predictors of readmission is essential in lowering readmission rate for these procedures.
  
  
  METHODS
  This is a retrospective case-control study of patients undergoing laparoscopic gastric bypass at Tufts Medical Center from 2007 to 2012. Variables analyzed included demographics, comorbidities, intraoperative events, postoperative complications, discharge disposition, and readmission diagnoses. Univariate analysis was used to identify factors associated with readmission, which were then subjected to multivariable logistic regression analysis.
  
  
  RESULTS
  We reviewed 358 patients undergoing laparoscopic gastric bypass, 119 readmits, and 239 controls. By univariate analysis, public insurance, body mass index >60 kg/m(2), duration of procedure, high American Society of Anesthesiologists (ASA) class, and discharge with visiting nurse services (VNA) were significantly associated with 30-day readmissions. In the regression model, duration of procedure, high ASA class, and discharge with visiting nurse services (VNA) remained significantly associated with readmission when controlling for other factors (odds ratio [OR] 1.523, 95% CI 1.314 to 1.766; OR 2.447, 95% CI 1.305 to 4.487; and OR 0.053 with 95% CI 0.011 to 0.266, respectively). The majority of readmissions occurred within the first week after discharge. Gastrointestinal-related issues were the most common diagnoses on readmission, and included anastomotic leaks, postoperative ileus, and bowel obstruction. The next 2 most common reasons for readmission were wound infection and fluid depletion.
  
  
  CONCLUSIONS
  Using readmission risk, we can stratify patients into tiered clinical pathways. Because most readmissions occur within the first postdischarge week and are most commonly associated with dehydration, pain, or wound issues, focusing our postoperative protocols and patient education should further lower the incidence of readmission.
authors.affiliation: Tufts University School of Medicine, Boston, MA. Electronic address: samantha.tayne@tufts.edu.
authors.forename: Samantha
authors.initials: S
authors.lastname: Tayne
authors.affiliation: Tufts University School of Medicine, Boston, MA.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Merrill
authors.affiliation: Department of Surgery, Tufts Medical Center and Tufts University School of Medicine, Boston, MA.
authors.forename: Sajani N
authors.initials: SN
authors.lastname: Shah
authors.affiliation: Department of Surgery, Tufts Medical Center and Tufts University School of Medicine, Boston, MA.
authors.forename: Julie
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Surgery, Tufts Medical Center and Tufts University School of Medicine, Boston, MA.
authors.forename: William C
authors.initials: WC
authors.lastname: Mackey
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors