The readmission contradiction: toward clarifying common misconceptions about bariatric readmissions and quality improvement.

BACKGROUND: Efforts to improve quality in U.S. medicine have included reimbursement penalties for readmissions.

OBJECTIVES: This study's first phase measured readmissions after initial bariatric surgery and analyzed surgical outcomes secondarily. The second phase aimed to identify nonclinical factors associated with bariatric readmissions.

SETTING: Rural U.S. academic hospital.

METHODS: This retrospective study analyzed a prospective database of patients undergoing initial Roux-en-Y gastric bypass or sleeve gastrectomy between May 1, 2007 and April 30, 2015. Phase I included readmission data as well as demographic and surgical outcomes data. Phase II focused on "nonclinical" data from readmitted patients including payor status (Medicare, Medicaid, Commercial, Geisinger Health Plan), distance from home to the index hospital, and utilization of a transfer center.

RESULTS: A total of 2275 patients were studied; 5.5% were readmitted. Of remissions, 48% were preventable and were most often associated with nausea, vomiting, and dehydration (gastrointestinal). Nonpreventable readmissions were significantly associated with major complications. No significant difference was found in overall or preventable readmission rates by payor. Distance from index hospital was not significantly associated with readmissions; however, 28% of readmitted patients were transferred from other healthcare facilities.

CONCLUSIONS: Payor status was not associated with increased risk for readmissions. Nearly half of all bariatric readmissions were preventable, identifying a quality improvement opportunity. However, 28% came through a transfer center, resulting in both better treatment and patient capture rates. Such quality improvement initiatives paradoxically risk increased reimbursement penalties.