Quality of Care Transition During Hospital Discharge, Patient Safety, and Weight Regain After Bariatric Surgery: a Cross-Sectional Study

Abstract

Purpose: Bariatric surgery is established as the gold standard in the treatment of severe obesity. However, a significant proportion of patients experience a substantial weight regain afterwards. Previous research focused predominantly on patients' personal factors. Yet, critical discharge process factors that contribute to patient's adherence after surgical interventions are rarely examined. This study investigated whether high quality of care transitions in discharge management influences weight regain and the likelihood of experiencing adverse patient safety incidents.

Materials and methods: A cross-sectional study with 578 patients after bariatric surgery was conducted. Participants answered a standardized assessment on the quality of care transition from hospital to home-, surgery-, and nutrition-related characteristics as well as patient safety incidents.

Results: Significant weight regain was observed 24 months after surgery. The association between time since surgery and weight regain was weaker in patients with high quality of care transitions (B = 2.27, p < .001). Higher quality of care transition was also significantly related to a lower likelihood of unplanned hospital readmissions (OR = 0.67) and fewer medication complications (OR = 0.48) after surgery.

Conclusion: This study sheds first light on the key influence of high quality of care transitions after bariatric surgery. Improvement efforts into effective discharge processes may establish smoother care transitions and help patients to assume responsibility and compliance with behavioral recommendations after surgery. Moreover, adverse patient safety incidents are less frequent after high quality care transitions indicating both high quality of health services for patients and reducing costs for the health care system.

Keywords: %TWL; Bariatric surgery; Care transition; Discharge management; Interaction effect; Moderation analysis; Patient empowerment; Patient safety.

Fig. 1

Percentage of total weight loss (%TWL) stratified for the time since bariatric surgery. Outliers are not displayed

Fig. 2

Percentage of total weight loss (%TWL) stratified for the time since bariatric surgery and the two most used surgical techniques (sleeve gastrectomy and Roux-en-Y gastric bypass). Outliers are not displayed

Fig. 3

Significant interaction effect of time since surgery and the quality of care transition on %TWL. The illustrated values were adjusted for the covariates “type of bariatric surgery” and “food intolerances”