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Quality of hospital discharge can impact weight gain and patient safety

Updated: Feb 22, 2023

The quality of care transition after bariatric surgery can impact weight gain as well as patient safety and hospitals need to design effective and patient-centred discharge processes to meet patient requirements and promote compliance according to German researchers. They found that adverse patient safety incidents are reduced after high quality care transitions indicating both high quality of health services for patients and reducing costs for the health care system.

“Insights into effects of care transitions after bariatric surgery may inform future improvement efforts to design patient-oriented care services that foster improved long-term surgical outcomes,” the study authors write. “Our study may inform practice interventions on patient-centred care transitions that promote adherence to post-surgical behaviour recommendations with notable effects on weight maintenance and mitigation of adverse patient safety incidents at home.”

The researchers carried out their study to investigate the role of quality of care transitions in patients’ weight regain after bariatric surgery and whether the effect of time lag since surgery on patients’ weight regain is weaker in patients with higher quality of care transitions. They also evaluated whether a higher quality of care transition was associated with reduced likelihood of adverse patient safety incidents unplanned hospital readmissions and medication complications etc.

Between March and May 2022, the investigators recruited 578 patients (435 female, 75%) and the outcomes revealed that the %TWL significantly increased over time, until a time lag of “up to 24 months.” At this point, a significant decrease in %TWL was observed compared to patients who indicated to have received surgery more than 24 months ago. These results point out that a significant weight regain was present in their patient cohort. There were no significant differences over the time between sleeve gastrectomy and Roux-en-Y gastric bypass in the variation of %TWL.

The mean score of quality of care transition was 3.11 and did not significantly differ regarding the type of bariatric surgery (p=0.38) or depending on the presence of a food intolerance (p=0.89). Patients’ rating of the quality of care transition was significantly lower in patients who had their surgery more than 24 months ago than patients who had their surgery less than 12 or 6 months ago (p<0.01). These results suggest that the quality of care transition moderated the effect of time since surgery on %TWL such as that patients who experienced a better transition of care process during hospital discharge reported a higher %TWL after 24 months. However, the weight regain was significantly lower compared to patients who experienced low quality of care transitions.

In total, 70 out of 498 individuals had an unplanned readmission to the hospital after their surgery, resulting in an incidence of 14.1%. Medication complications after discharge were experienced by 60 out of 498 participants, indicating an incidence of 12.1%. The quality of care transition is associated with both less unplanned hospital readmissions (OR = 0.67; 95% confidence interval [CI], 0.47–0.96) and fewer medication complications after bariatric surgery (OR = 0.48; 95% CI, 0.32–0.69) when controlled for the time since surgery. These results corroborate that the quality of care transition during the hospital discharge process is a crucial success factor for medium-term success and mitigation of patient safety incidents in bariatric surgical care.

“Specifically, our results underline that weight regain is a challenge for patients after bariatric interventions. Nevertheless, we showed that weight regain is mitigated when the quality of care transition during hospital discharge is high,” the authors write. “Moreover, our findings show that patient safety incidents were more likely when the quality of care transition was low.”

The high quality of care transitions was associated with lower likelihood of unplanned hospital readmission as well as fewer medication complications at home after bariatric surgery. Both results highlight that measures to foster patient safety are not limited to the actual intervention and care in the hospital but also play an important role in the discharge process.

Overall, the findings underline that effective patient discharge processes support the medium-term success of bariatric surgery and prevent the occurrence of adverse patient safety incidents at home. Hospitals and healthcare professionals should invest resources into the discharge process to foster patients’ engagement and their compliance to behavioural recommendations with the aim to prevent weight regain as well as patient safety incidents after bariatric surgery.

“Future studies should observe compliance to post-bariatric surgery nutrition recommendations or micronutrient supplementation behaviour,” the authors concluded. “Furthermore, future studies should consider possible mediating variables to shed light on the influence of the quality of care transition on the engagement and empowerment of patients after bariatric surgery. Especially, prospective studies should be conducted to replicate our findings as well as to investigate causal relations within individual patient journeys.”

The outcomes were reported in the paper, “Quality of Care Transition During Hospital Discharge, Patient Safety, and Weight Regain After Bariatric Surgery: a Cross-Sectional Study,” published in Obesity Surgery.

To access this paper, please click here


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