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

**Background:** Bariatric surgery is the gold standard for severe obesity, but 20–25% of patients experience significant weight regain, typically 18–24 months post-surgery. Prior research has focused on patient-level factors (e.g., preoperative BMI, nutrition, physical activity) but has largely neglected organizational factors such as the quality of care transitions during hospital discharge. High-quality care transitions—characterized by effective information transfer and patient preparation to promote empowerment and self-management—have been linked to better outcomes in other settings but have not been systematically studied in bariatric surgery. This study investigated whether the quality of care transitions moderates weight regain and is associated with fewer patient safety incidents.

**Methods:** A cross-sectional study was conducted between March and May 2022. Participants (N = 578 after exclusions) were recruited from the Obesity and Metabolic Surgery Center of Alfried Krupp Hospital (Essen, Germany) and via online social media groups. Eligibility criteria were age >18 years, fluency in German, and prior bariatric surgery (primary or revisional). Participants completed a standardized online survey including the 15-item Care Transition Measure (CTM; Cronbach's α = 0.95), self-reported pre- and postoperative body weight, surgery-related characteristics, and patient safety incidents (unplanned hospital readmissions and medication complications). The primary outcome was percentage of total weight loss (%TWL). Stepwise linear regression with moderation analysis and binomial logistic regression were used.

**Key Results:** Significant weight regain was observed after 24 months: %TWL increased from 17.8% (<6 months) to 38.6% (<24 months) then decreased to 33.3% (>24 months) (F(3,483) = 48.08, p < .001). The interaction between time since surgery and quality of care transition was significant (B = 2.27, p < .001), with a model R² change of 2.7%. Patients with high CTM scores (M + 1 SD) showed a weaker weight regain trajectory after 24 months compared to those with low CTM scores. Higher quality of care transition was associated with lower odds of unplanned hospital readmission (OR = 0.67; 95% CI, 0.47–0.96) and fewer medication complications (OR = 0.48; 95% CI, 0.32–0.69), controlling for time since surgery. The incidence of unplanned readmission was 14.1% (70/498) and medication complications 12.1% (60/498).

**Clinical Implications:** This study provides the first evidence that organizational factors—specifically the quality of hospital discharge processes—are associated with long-term weight outcomes and patient safety after bariatric surgery. High-quality care transitions may promote patient empowerment, self-efficacy, and compliance with post-surgical behavioral recommendations, thereby mitigating weight regain. The findings suggest that hospitals should invest in patient-centered discharge processes, including clear communication about medications, warning signs, and follow-up plans. Health policy efforts to strengthen discharge management could reduce both adverse outcomes and healthcare costs. Limitations include the cross-sectional design (precluding causal inference), potential recall bias, and lack of direct adherence or compliance measurement. Prospective longitudinal studies across multiple centers are needed to confirm these findings.