Care Fragmentation Following Bariatric Operations: A National Analysis
Konmal Ali, Troy Coaston, Ayesha P. Ng, Lavender Micalo, Sara Sakowitz, Amulya Vadlakonda, Barzin Badiee, Syed Shaheer Ali, Peyman BenharashBackground
Although existing work has evaluated outcomes associated with care fragmentation (CF), these adverse consequences may be accentuated in patients undergoing bariatric operations. This retrospective study examined the association of CF with clinical and financial outcomes among patients receiving bariatric surgery.
Methods
All adult (≥18 years) records for bariatric operations were tabulated from the 2016-2021 Nationwide Readmissions Database. Patients with nonelective rehospitalization at a non-index facility within 30 days of index discharge comprised the CF cohort (others: No-CF). Multivariable linear and logistic models were developed to assess the association of care fragmentation with outcomes of interest.
Results
Of an estimated 38,842 patients, 5591 (17.0%) comprised the CF cohort. Compared to No-CF, CF was older, less likely to be female, and more frequently insured by Medicare. Following comprehensive risk adjustment, CF demonstrated increased odds of respiratory (adjusted odds ratio [AOR] 1.61, 95% CI 1.37-1.90), renal (AOR 1.56, 95% CI 1.38-1.76), and thromboembolic (AOR 2.03, 95% CI 1.71-2.41) complications. Additionally, those who experienced CF demonstrated increased odds of non-home discharge (AOR 2.03, 95% CI 1.70-2.42).
Conclusions
Care fragmentation is associated with increased mortality, complications, non-home discharge, and hospitalization costs. Initiatives such as patient education, harmonizing postoperative care, and facilitating returns to the index hospitals may minimize the adverse effects of CF to improve the continuation of care following bariatric operations.