Relationship between surgeon and hospital volume and readmission after bariatric operation

BACKGROUND: Few studies have focused on the relationship between provider volume and short-term readmissions among bariatric operation patients. STUDY DESIGN: Using New York State's inpatient discharge database, we identified adults undergoing a bariatric procedure between January 1, 2003, and November 30, 2003 (n = 7,868). After preliminary descriptive analyses, a multiple logistic regression model was constructed to examine the relationship between surgeon and hospital volume and readmission after 30 days of discharge for bariatric operation, while controlling for demographics, comorbidity, and length of index hospitalization. RESULTS: Among patients undergoing bariatric operation in New York in 2003, 7.6% were readmitted within 30 days of discharge after their operation. The most common readmission diagnosis was "digestive system complications of surgical care." Multiple logistic regression showed that both surgeon and hospital volume were significantly associated with short-term readmissions. Patients operated on by a low-volume surgeon (<= 25 procedures per year) were significantly (p < 0.001) more likely to be readmitted as compared with those operated on by a medium-volume surgeon (26 to 150 procedures per year); patients operated on by high-volume surgeons (>150 procedures per year) were also significantly (p < 0.001) more likely to be readmitted compared with those operated on by medium-volume surgeons. Patients in each of the lower hospital volume categories were more likely to be readmitted compared with the highest volume category (>300 procedures per year) (<= 100 procedures, odds ratio [OR] = 1.57; 95% CI, 1.38-2.16; 101 to 200 procedures, OR = 2.88; 95% CI, 2.17-3.82; 201 to 300 procedures, OR = 2.21; 95% CI, 1.71-2.86). CONCLUSIONS: There is an important relationship between surgeon and hospital volume and short-term readmission after bariatric operation.