ABSTRACT
Peter Ng Raleigh NC1, Afton Carducci Raleigh NC1, Lindsey Sharp Raleigh NC1, Dustin Bermudez Raleigh NC1, Linda Youngwirth Durham NC1, Tricia Burns Raleigh NC1, Erica McKearney Raleigh NC1, Lauren Massey Raleigh NC2 UNC Rex Bariatric Specialist1 UNC REX Hospital2 Introduction: The COVID-19 pandemic stressed inpatient hospital capacity and restricted elective surgery, limiting bariatric access. A novel outpatient home health program was introduced to support early discharge after bariatric surgery and preserve inpatient healthcare resources for COVID. This retrospective study evaluates the clinical/financial impact of enhanced home health in early post-operative bariatric recovery. Methods: Our program offered enhanced home health (EHH) to all bariatric patients with insurance inclusion. Patients were separated into 3 care tiers based on BMI and comorbidity with each tier adding complementary services. Tier 1 provided home intravenous hydration, anti-emetics x 3 days, and home nursing care. Tier 2 (BMI>50 kg/m2) added physical therapy. Tier 3 (plus comorbidity) added virtual primary care medical consultation. Patients were planned for scheduled discharge on post-operative day one by 10 am, if deemed medically appropriate. Results: From December to June 2021, 355 bariatric cases were performed, 158 non-EHH patients and 197 EHH patients with the following combined case mix: duodenal switch (54.6%), revision (17.2%), sleeve gastrectomy (16.6%), SADI-S (7.7%), and Roux-en-Y gastric bypass (3.9%). The prior year average hospital length of stay (LOS) was 2.0 days, non-EHH LOS of 2.0 days, versus EHH LOS of 1.5 days. A 6% reduction in direct variable costs per case was demonstrated, $9607 non-EHH versus $9036 EHH. Comparative readmission rates for nausea/vomiting/dehydration (NVD) equaled 3.8% for non-EHH and 1.5% for EHH patients. Conclusion: Enhanced home health preserved access to bariatric care while decreasing length of stay, variable costs, and reduced readmission for NVD.
ABSTRACT
Benjamin Clapp El Paso TX1, Omar Ghanem Rochester MN2, Pavlos Papasavas Hartford CT3, John Marr El Paso TX1, Jisoo Kim El Paso TX1, Wayne English Nashville TN4 Texas Tech HSC Paul Foster School of Med1 Mayo Clinic2 Hartford Hospital3 Vanderbilt University4 Background: Revisional bariatric surgery (RBS) is the third most common bariatric surgery performed in the United States. RBS is likely to increase with time and may soon surpass Roux-en-Y gastric bypass (RYGB) in volume. The Metabolic and Bariatric Surgery Quality Improvement and Accreditation Program (MBSAQIP) tracks bariatric cases. Our goal was to evaluate the MBSAQIP for revisional bariatric surgery trends. Methods: The 2020 MBSAQIP Participant Use File (PUF) was used to look at the number and type of RBS and compared to similar MBSAQIP data over the previous five years. All cases listed under the Revision tag were included in the analysis. Procedures considered included RYGB, sleeve gastrectomy (SG), adjustable gastric band (AGB), biliopancreatic diversion (BPD) and single anastomosis duodenoileal bypass (SADI). Descriptive statistics were used. Results: There were 197,812 cases reported in the PUF. Of these, 26,652 (13.5%) were revisions, conversions or reoperations. Stapled non emergent procedures dominated with 19,763. There were 4,291 SG conversions and 682 re-sleeves. There were 9,217 RYGB conversions and 3,221 revisions. There were 2,067 AGB revisions, 883 BPD revisions or conversions, and 424 SADI revisions or conversions. Conclusions: A 40.2% percent increase of RBS was seen from 2015 to 2019 but COVID was responsible for a 22.8% decrease in 2020. It is anticipated that RBS will resume its upward trend after the pandemic passes. AGB revisions have decreased, while SADI revisions have increased. The largest percentage of growth has been in SG conversions.