Date of Award

January 2021

Document Type

Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Joan Kearney

Abstract

The prevalence of 30-day readmission after bariatric surgery is 0.6% to 11.3%, with a single hospital readmission nearly tripling the average 180-day cost of the surgery. Given that nearly 50% of early readmissions are preventable, close postoperative follow-up may allow for early identification of high-risk patients and preventative interventions.

This 7-month quality improvement project augmented clinical follow up post-bariatric surgery by incorporating a 7-10 day post-discharge call by an RD following a routine 1-3 day post-discharge call by an APP. Impact on readmission rate was examined. 166 participants included men and women ≥18 years of age, status post primary bariatric surgery only.

The proportion of patients experiencing a post-surgery hospital readmission or ED visit was evaluated across the sample, and stratified by procedure type and number of calls answered. Post-project readmission and ED visits were compared to those from the NYP Semi-Annual Report (SAR) using 2-sample tests of proportions. A clear downward trend was noted in the overall readmission rate for project participants (6.5% (SAR) vs. 4.8% (Project)). Readmission rate was related to procedure type: 9.2% (SAR) vs. 7.1% (Project) for post Roux-en-Y gastric bypass, and 5.4% (SAR) vs. 4% (Project), for sleeve gastrectomy. Patients who only connected on the 7-10 day post-discharge call had 0 readmission and post-operation ED visits.

Findings here are promising. Additional projects should be conducted on a larger scale and include factors that may place patients in a ‘higher risk’ category for readmission e.g., obstructive sleep apnea, diabetes, depression/anxiety, and history of DVT/PE.

Keywords: bariatric surgery, readmission, hospital readmission, sleeve gastrectomy, Roux-en-Y gastric bypass, readmission rates, readmissions, abdominal pain, nausea, vomiting, dehydration, complications

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 02/28/2022

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