Many post-procedural hospital re-admissions due to nausea, dehydration

Patients who present for hospital re-admission following Roux-en-Y gastric bypass surgery frequently present with nausea, vomiting and dehydration.

Those re-admitted to hospitals within 90 days following their surgical procedure present with problems that may be treated with appropriate outpatient mechanisms, according to study results presented at the 25th Annual Meeting of the American Society for Metabolic and Bariatric Surgery.

“Health insurance payers have concerns about the costs of bariatric procedures,” said Todd A. Kellogg, MD, assistant professor of surgery at the University of Minnesota Medical School in Minneapolis. “These are mainly related to early re-admissions and re-operations. This has been studied, but good studies are lacking primarily because administrative data tend to be inaccurate.”

The researchers examined the electronic medical records of 1,222 patients who underwent gastric bypass and were re-admitted to the hospital within 90 days following the procedure. They reported that 173 patients made 252 visits to the hospital within the first three months following Roux-en-Y gastric bypass procedures. Fifty-eight percent of those re-admissions in the first month following surgery were related to nausea or vomiting, dehydration, benign abdominal pain or wound problems. In the second month, 56% of the admissions were related to the same problems; with 49% in the third month.

“The unemployed and those on disability are more likely to present to the emergency department and were more likely to be re-admitted, so perhaps outpatient support mechanisms may reduce unwarranted emergency department visits and readmissions,” he said. “In addition, social service interventions for unemployed or disabled patients may reduce unnecessary visits.” – by Eric Raible

I agree that we need to be aware of both the frequency of and the cause of emergency department visits and re-admissions. In this regard, we also need to be aware that some re-admissions occur in other nearby hospitals. If nausea and vomiting are indeed linked to stoma narrowing, can this be anticipated in the hospital and by doctors such that the patient might be hydrated, have an endoscope, and then be discharged from a recovery room rather than actually being readmitted to the hospital?

– John J. Gleysteen, MD

Professor of Medicine, University of Alabama-Birmingham

For more information:
Kellogg T. Patters of short-term readmission-reoperation following Roux-en-Y gastric bypass. #PL-50. Presented at: The 25th Annual Meeting of the American Society for Metabolic and Bariatric Surgery; June 15-20, 2008; Washington D.C.