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DROP improvement programme reduces readmissions

Many bariatric surgery re-admissions are primarily due to preventable causes such as nausea, vomiting, electrolyte and nutritional depletion

While the average hospital saw 30-day readmission rates for bariatric surgery patients drop by about 14 percent, some hospitals had reductions as much as 32 percent after implementing a new quality improvement programme, according to research presented at ObesityWeek 2016. The Decreasing Readmissions through Opportunities Provided (DROP) programme 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 emphasised readmissions as an opportunity for improvement in healthcare.

John Morton

“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, Dr John M Morton, Director of Bariatric Surgery at Stanford Hospital & Clinics and immediate past-president, ASMBS. “Through a true collaboration among hospitals and centres, 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, “Decreasing Readmissions through Opportunities Provided (DROP): The First National Quality Improvement Collaborative from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)”, Morton explained that 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.

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 greatest decrease in readmission occurred for hospitals with the highest quartile of 30-Day readmissions at pre-intervention. These highest quartile readmission hospitals had a baseline rate of 8.11%, which fell to 6.63% (p=0.02) in the first DROP quarter and continued to fall to 5.51% in the second DROP quarter (p<0.0001). This combined readmission rate of 6.08% for the first two quarters of DROP for highest quartile of hospitals was also a significant decline (p<0.0001).

For readmissions <24 hours, the highest quartile hospitals had significant declines from 2.76% Pre-Intervention to 1.79% for first two DROP Quarters, p=0.001. The causes in order of prevalence for readmission remained the same pre- and post-intervention (nausea and vomiting, fluid, electrolyte, or nutritional depletion, other, abdominal pain, anastomotic/staple line leak, bleeding, intestinal obstruction). The adherence rate to the 8 DROP processes was 6.95 First Quarter, 7.23 Second Quarter, and 6.97 1st and 2nd quarters combined.

Overall, in the year prior to the program, centres 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 programme.

“The highest quality care in bariatric surgery is occurring at MBSAQIP accredited centers,” said Dr Samer G Mattar, 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.” 

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American Society for Metabolic and Bariatric Surgery

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