Gastroesophageal Reflux Predicts Utilization of Dehydration Treatments After Bariatric Surgery
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ORIGINAL CONTRIBUTIONS
Gastroesophageal Reflux Predicts Utilization of Dehydration Treatments After Bariatric Surgery Keri A. Seymour 1
&
Megan C. Turner 1 & Maragatha Kuchibhatla 2 & Ranjan Sudan 1
Received: 11 July 2020 / Revised: 3 October 2020 / Accepted: 6 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Dehydration treatments (DT) provide intravenous fluids to patients in the outpatient setting; however, the utilization of DT is not well-described. We characterize the cohort receiving DT, the first year it was recorded in a bariatric-specific database. Setting A retrospective cohort analysis of patients undergoing bariatric surgery between January 1, 2016, and December 31, 2016, in 791 centers in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data file. Methods Patients ≥ 18 years with a body mass index (BMI) ≥ 35 kg/m2 who underwent laparoscopic adjustable gastric band (LAGB), sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (LRYGB), and biliopancreatic diversion with duodenal switch (LBPD/DS) were identified. Unadjusted and adjusted rates of DT were analyzed. In addition, adjusted rates and indication for readmission were reviewed. Results The overall rate of dehydration treatments was 3.5% for the 141,748 bariatric surgery cases identified. Patient comorbidities of gastroesophageal reflux (GERD) (odds ratio (OR) 1.49; 95% CI, 1.40–1.59), insulin-dependent diabetes (OR = 1.19; 95% CI, 1.07–1.33), and LRYGB (OR = 1.45; 95% CI, 1.36–1.54) were associated with higher odds of DT. DT only had the highest odds of readmission (OR = 6.22; 95% CI, 5.55–6.98) compared to other outpatient visits. Nausea and vomiting, or fluid, electrolyte, or nutritional depletion was the most common indication for readmission in all groups. Conclusions Patients with GERD utilized dehydration treatments after bariatric surgery. DT was highly associated with readmissions, and a better understanding of the clinical application of DT will allow bariatric centers to develop programs to further optimize outpatient treatments. Keywords Gastroesophageal reflux . Diabetes . Dehydration treatments . Bariatric surgery . Readmission . Outpatient visits . Gastric bypass . Duodenal switch
Introduction The Hospital Readmissions Reduction Program introduced by the Centers for Medicare and Medicaid Services in 2012 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-05043-9) contains supplementary material, which is available to authorized users. * Keri A. Seymour [email protected] 1
Department of Surgery, School of Medicine, Duke University, 407 Crutchfield St, Durham, NC 27704, USA
2
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
reduced reimbursement to hospitals with high readmission rates [1]. Prevention of unplanned readmission was the focus of quality improvement programs [2–4] with the challenge to decrease readmission rates that range
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