Background

30-day readmissions have been used as a quality improvement measure as well as a marker for penalizing institutions with the literature suggestive of > 50% of readmissions being secondary to preventable non-surgical causes, most commonly, nausea/vomiting, dehydration, and abdominal pain. We sought to implement outpatient infusion services for patients and earlier one week follow-up appointments to decrease utilization of inpatient and ED resources.

Methods

Retrospective chart review utilizing MBSAQIP data for metabolic surgery patients between 1/2021 - 9/2023 at a single institution (N = 57.) Total ED and inpatient readmissions were evaluated both for the primary institution and presentations to hospitals within the CRISP program as well as the overall utilization of IV hydration utilization.

Results

A total of 57 patients underwent outpatient IV hydration with 26 of those patients requiring further emergency department evaluations (both before and after undergoing hydration.) An additional 17 patients were formally admitted both from the infusion center and from the ED with further interventions including 24 EGDs performed on an inpatient and outpatient basis with therapeutic dilations performed in 18 patients, 15/18 were sleeve gastrectomies. Notably, patients who underwent a band to bypass conversion 19% (4/21) required IV hydration more frequently compared to primary sleeve gastrectomy 5.9% (41/694), bypass revisions 5.17% (3/58), sleeve to bypass 6% (3/50) and bypasses 5.17% (6/116.)

Conclusions

More work will need to done to reinforce follow-up with limited success with more aggressive outpatient utilization of intravenous fluid services for preventable ED evaluations and re-admissions with longer follow-up.