Evaluating organizational factors associated with postoperative bariatric surgery readmissions.
BACKGROUND
Several patient and surgical characteristics have been identified as risk factors for readmission after bariatric surgery, but there is a paucity of information on how organizational factors influence this metric.


OBJECTIVE
To evaluate the association between readmissions and several organizational factors, including compliance with best practices to reduce unplanned hospital visits, major complication rates, and the emergency department-sourced readmission (EDSR) rate.


METHODS
The Michigan Bariatric Surgery Collaborative database was used to identify patients undergoing primary bariatric procedures. Using an indirect standardization process, each site's observed-to-expected ratio for 30-day readmissions was calculated. The association between each site's adjusted readmission rate and each organizational factor was calculated with Pearson correlation coefficients.


RESULTS
There was significant variation among the sites' adjusted rates of readmission, EDSR, best practice compliance rates, and major complication rates. There was a moderate association between each site's adjusted readmission rate and the rate of EDSR (r = .53) and major complications (r = .53). However, the association between bariatric centers' compliance with best practices to reduce unplanned hospital visits and readmission rates was fairly weak (r = -.14).


CONCLUSIONS
Bariatric centers with higher rates of major complications and sites with emergency departments that are less likely to treat and discharge patients are more likely to have higher readmission rates. Even though compliance with best practices to reduce readmissions may be important, results suggest that it does not significantly influence the readmission rates at sites that perform only these basic measures or perform them inadequately.
Department of Surgery, Boston Medical Center, Boston, Massachusetts. Electronic address: ryan.macht@bmc.org.
Ryan
R
Macht
Michigan Bariatric Surgery Collaborative, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
Ruth
R
Cassidy
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
Howard
H
Cabral
Center for the Assessment of Pharmaceutical Practices and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
Lewis E
LE
Kazis
Michigan Bariatric Surgery Collaborative, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Amir
A
Ghaferi
D050110:Bariatric Surgery / Q000009:adverse effects* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006276:Health Facility Size / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012307:Risk Factors; D013531:Surgicenters / Q000706:statistics & numerical data
Bariatric surgery; Emergency department characteristics; Postoperative complications; Readmissions