New quality improvement program reduces hospital readmission rates for weight-loss surgery patients

American Society for Metabolic and Bariatric Surgery (ASMBS)Nov 2 2016

While the average hospital saw 30-day readmission rates for weight-loss surgery patients drop by about 14 percent, some hospitals had reductions as much as 32 percent after implementing a new quality improvement program, according to new research presented today at ObesityWeek 2016, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The annual conference is hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).

The Decreasing Readmissions through Opportunities Provided (DROP) program is the first initiative focused on hospital readmissions developed through Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), a joint program of the American College of Surgeons (ACS) and the ASMBS. National payors, including Centers for Medicare and Medicaid Services (CMS), have emphasized readmissions as an opportunity for improvement in healthcare.

"Weight-loss surgery has already become one of the safest operations in America, comparable to gallbladder and joint replacement surgery, but we saw readmissions as an area we could improve even further," said lead study author John M. Morton, MD, Director of Bariatric Surgery at Stanford Hospital & Clinics and immediate past-president, ASMBS. "Through a true collaboration among hospitals and centers, we bundled best pre-operative and post-operative programs and practices that focused on key triggers for readmissions, taking advantage of a bariatric program's multi-disciplinary approach."

According to the researchers, many bariatric surgery readmissions are primarily due to preventable causes such as nausea, vomiting, electrolyte and nutritional depletion.

In the study, DROP was implemented by 128 MBSAQIP Comprehensive Centers between March 2015 and March 2016 for patients undergoing primary laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, or laparoscopic Roux-en-Y gastric bypass.

In the year prior to the program, centers had a 30-day readmission rate of 4.79 percent with 1,446 readmissions from 30,204 cases. Six months after starting the DROP program, the readmission rate had fallen by an average of 14 percent. The reduction in readmissions was more than three times that (32%) for hospitals in the top quartile of readmissions before the start of the program.

DROP components spanned preoperative to postoperative services including educational videos, inpatient nutritional consults, prescription medication management, postop surgeon and nutritionist visits, and discharge checklists. Of the eight interventions, the post-operative visit with the nutritionist provided the most impact.

"The highest quality care in bariatric surgery is occurring at MBSAQIP accredited centers," said Samer G. Mattar, MD, a bariatric surgeon and professor of surgery at Oregon Health & Science University (OHSU), who was not involved in the study. "This study shows that we can harness the best practices that are occurring in these institutions and spread them throughout the country for the benefit of our patients."

Researchers plan to report on the 12-month impact of the DROP initiative on 30-day readmissions, complications, and patient satisfaction at ObesityWeek 2016.

MBSAQIP, which was established in 2014, accredits inpatient and outpatient bariatric surgery centers in the United States and Canada that have undergone an independent, voluntary, and rigorous peer evaluation in accordance with nationally recognized bariatric surgical standards. Bariatric surgery accreditation not only promotes uniform standard benchmarks, but also supports continuous quality improvement.

Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity and many related conditions and results in significant weight loss. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques. The risk of death is about 0.1 percent and the overall likelihood of major complications is about 4 percent.

According to the Centers for Disease Control and Prevention (CDC), in 2011-2014, the prevalence of obesity was just over 36 percent in adults, with a higher prevalence among women than men (38.3% vs. 34.3%) and older than younger adults (37% vs. 32.3%). Obese is medically defined as having a body mass index (BMI), a measure of height to weight, that's more than 30. The ASMBS estimates about 24 million Americans have severe obesity, which would mean a BMI of 35 or more with an obesity-related condition like diabetes or a BMI of 40.