• Yen-Yi Juo, Usah Khrucharoen, Yas Sanaiha, Yijun Chen, and Erik Dutson.
• Center for Advanced Surgical and Interventional Technology (CASIT), University of California Los Angeles, Los Angeles, CA, USA.
• Obes Surg. 2018 Dec 1; 28 (12): 3795-3800.

BackgroundCompromised access following bariatric centers-or-excellence designations may have led to increased incidence of non-index readmissions and worsened care fragmentation. We seek to evaluate risk factors and impact of non-index readmissions on short-term mortality during readmission using a national bariatric registry data from 2015.MethodsA retrospective cohort study was performed using a national clinical database. Multivariate logistic regression models were developed to quantify association between non-index readmissions and 30-day mortality among bariatric patients with 30-day readmissions.ResultsA total of 4704 patients were identified as undergoing bariatric surgery and readmitted within 30 days. Of these, 325 (6.9%) patients were readmitted to a non-index facility while the rest were hospitalized at the original hospital. Patient characteristics were largely similar between the two comparison groups, although patients with in-hospital complications and non-home disposition during the initial stay were more likely to experience non-index readmissions. Multivariate regression demonstrated that non-index readmission was associated with an adjusted odds ratio of 4.4 for 30-day mortality (95% confidence interval 2.6-9.2, p < 0.01). The most common reason for mortality for both index and non-index readmissions was pulmonary embolism.ConclusionsCare fragmentation may lead to increased 30-day mortality during readmissions following bariatric surgery. Heightened vigilance and longitudinal follow-up planning is recommended for patients with elevated risk for venous thromboembolism.

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