Emergency department encounters, hospital admissions, course of treatment, and follow-up care for behavioral health concerns in patients after Roux-en-Y gastric bypass surgery.

BACKGROUND: The benefits of bariatric surgery are well-established, however, concerns surrounding postoperative psychiatric destabilization and alcohol misuse remain. Research has initiated the process of identifying risks associated with bariatric surgery, although less is known regarding when or why psychiatric hospitalizations occur postoperatively. OBJECTIVES: The goal of the current study was to examine the incidence of, and contributing factors to, behavioral health-related emergency room (ER) encounters and hospitalization after bariatric surgery. SETTING: Integrated multispecialty health system with an accredited bariatric surgery program. METHODS: Retrospective review of patients who underwent Roux-en-Y gastric bypass (RYGB) surgery and had been readmitted to the hospital or presented to the ER after bariatric surgery at least once for a behavioral-health related reason. RESULTS: Of 1449 patients, 93 had at least 1 psychiatric or substance use-related ER visit/hospitalization post-surgery and were included in the study; 53% had 1 ER/hospital encounter after bariatric surgery; 24% had 2 encounters, 11% had 3-4 encounters, and 10% of patients had ≥5 encounters. Across 267 postbariatric surgery encounters, 42.4% were due to alcohol-related problems. The index presentation for alcohol-related reasons occurred at a mean of 1942 days (approximately 5.3 yr; SD = 1217 d). Patients' index presentation for a psychiatric concern (41.3%) occurred at a mean of 1278 days (3.5 yr; SD = 1056 d) post-surgery. CONCLUSION: A significant percentage of patients who present to the ER or hospital for behavioral health reasons after RYGB surgery had alcohol-related problems, long after their surgery. Psychologists working with bariatric surgery teams should prioritize ongoing assessment of and education on alcohol misuse in those seeking RYGB and in the long-term postoperative period.

Readability of the Patient Education Section of the AOFAS Website.

BACKGROUND: One of the goals of the AOFAS website is to provide easily understandable information about orthopaedic foot and ankle conditions to the public. However, validation of this goal has not been conducted. Evaluation of text reading level is frequently performed using the Flesch-Kincaid formula (FKF). This study evaluated whether the patient information section of the AOFAS website meets recommended readability guidelines for medical information. MATERIALS AND METHODS: Seventy-nine publicly accessible entries within the patient education section of the AOFAS website were analyzed for grade level readability using the FKF. RESULTS: Two entries were unable to be effectively evaluated using the FKF. The average grade reading level of all patient education entries was 8.3 (95% CI 7.8 to 8.9). Only 20.8% of entries were at or below a 6th grade reading level. Almost 30% were above the 8th grade level. The average grade levels of the constituent sections were: ;;Ailments and Conditions'', 8.7; ;;Steps to Recovery'', 7.1; ;;Adult Feet'', 8.3; ;;Children's Feet'', 7.5; ;;Foot Health and Fitness'', 7.8; ;;Shoes'', 8.5; and ;;Glossary'', 10.1. The percentage of entries within these sections below a 7th grade reading level were 13%, 30%, 0%, 0%, 43%, 24% and 0%, respectively. CONCLUSION: The percentage of entries at or below the recommended 6th grade reading level on the AOFAS website compared favorably with other orthopaedic organizations' websites. However, the majority still exceeds a recommended reading level. To enhance the readability of patient education materials, we believe use of computer aided readability assessment tools should be considered in future website revisions.