Bariatric surgery patients with nausea and vomiting may benefit from walk-in hydration clinics

By Lorraine L. Janeczko

ATLANTA (Reuters Health) - Patients who need rehydration after bariatric surgery can be managed at walk-in hydration clinics, researchers said at Obesity Week 2013, the first annual joint meeting of the American Society for Metabolic and Bariatric Surgery and The Obesity Society.

As an alternative to rehospitalizing bariatric patients after surgery for hydration and nausea control, the Cleveland Clinic opened an outpatient facility where patients can receive IV hydration and anti-emetic medication and return home.

"Our ambulatory hydration clinic keeps our patients out of the hospital and decreases the hospital's readmission rate," co-author Dr. Stacy Brethauer of the Clinic's Bariatric and Metabolic Institute told Reuters Health.

Fluid and electrolyte imbalance is the leading cause of readmission after bariatric surgery, and the outpatient clinic significantly reduced patients' readmission rate, "which primarily had been related to nausea, vomiting and dehydration," he said.

The researchers opened their walk-in center at Cleveland Clinic in 2011. For the presentation at the meeting November 13, they analyzed 30-day readmission rates after laparoscopic Roux-en-Y gastric bypass (LRYGB) during the 18 months before and after they opened the clinic.

During the 18-month period after the clinic was opened, 608 patients had laparoscopic Roux-en-Y gastric bypass surgery. Eighty walk-in patients (4.4 patients per month) received IV hydration therapy, including 25 (31%) within 30 days after surgery. After their fluid therapy, 75 (94%) were sent home and only five (6%) were readmitted to the hospital.

In the 18 months preceding the opening of the clinic, 624 patients had the same type of gastric bypass. But the 30-day readmission rate of LRYGB patients dropped markedly after the clinic opened - from 16.5% to 9.5%, according to the research team (p<0.001).

Dr. Brethauer couldn't say exactly what the denominators were. But, he said, "Readmission rates reflect the percentage of patients that get readmitted to the hospital within 30 days of surgery, so the denominator is the number of surgeries in the previous 30 days. I'm out of the office and don't recall the numbers for those time periods but it's a moving target depending on how many cases we did in the prior 30 days. We average 50-60 bariatric cases/month."

He added, "The readmission rates include readmission for any reason but the most common reason was dehydration which is why we saw the number move after we started the rehydration clinic."

"No other studies that I'm aware of demonstrate this type of model to manage this type of problem, so it's somewhat novel. However, it makes a lot of sense and we hope that it provides guidance for other programs to establish these types of hydration clinics. Clearly in our practice this has worked very well," Dr. Brethauer said.

"These are important findings," said Dr. Scott Shikora, past president of American Society for Metabolic and Bariatric Surgery and director of the Center for Metabolic Health of Brigham and Women's Hospital in Boston. "This prevents readmissions to the hospital so patients aren't exposed to infection and all that goes on. Generally if you hydrate your patients and they go home they don't have problems the second time," he told Reuters Health.

"This is a great idea that can result in tremendous cost savings to the health care system, and it is something that my hospital and I are looking to do as well," he said. Dr. Shikora was not involved in the study.

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