BACKGROUND: Outcomes for patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery have improved, but a subset of patients who significantly utilize more resources exists. We identified preoperative variables that increase resource utilization in patients who undergo LRYGB. METHODS: Patients who underwent LRYGB in 2007 and 2008 were identified from the NSQIP database. Variables that indicated resource utilization were operative time (OT), length of stay (LOS), and occurrence of postoperative complications. Analyses were performed by using multivariate analysis of variance and logistic regression. RESULTS: Of 14,251 patients with a mean age of 44.6 (± 11.1) years, 19.4% were men. The national 30-day morbidity and mortality were 4.5% and 0.17%, respectively. The median OT was 128 min (interquartile range (IQR), 100-167), and the median LOS was 2 days (IQR, 2-3). Bleeding disorder, male gender, African American race, increasing weight, and age were significantly associated with increased OT (p < 0.05 for all). Severe chronic obstructive pulmonary disease, bleeding disorder, increasing age, and anesthesia time were associated with increased length of stay (p < 0.05). Preoperative dialysis dependence (odds ratio (OR), 8.5; 95% confidence interval (CI), 2.3-32.3) and dyspnea at rest (OR, 3.3; 95% CI, 1.7-6.3) were the greatest predictors of postoperative complications. Emergency case, bleeding disorder, prior percutaneous coronary intervention, and increasing operative time also were significantly associated with increased postoperative complications on multivariate logistic regression analysis (p < 0.05 for all). CONCLUSIONS: Age, sex, race, obesity, and some medical comorbidities affect outcomes and increase resource utilization. Optimization of modifiable factors and careful patient selection are needed to facilitate further improvement in outcomes and resource utilization.
BACKGROUND: Outcomes for patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery have improved, but a subset of patients who significantly utilize more resources exists. We identified preoperative variables that increase resource utilization in patients who undergo LRYGB. METHODS:Patients who underwent LRYGB in 2007 and 2008 were identified from the NSQIP database. Variables that indicated resource utilization were operative time (OT), length of stay (LOS), and occurrence of postoperative complications. Analyses were performed by using multivariate analysis of variance and logistic regression. RESULTS: Of 14,251 patients with a mean age of 44.6 (± 11.1) years, 19.4% were men. The national 30-day morbidity and mortality were 4.5% and 0.17%, respectively. The median OT was 128 min (interquartile range (IQR), 100-167), and the median LOS was 2 days (IQR, 2-3). Bleeding disorder, male gender, African American race, increasing weight, and age were significantly associated with increased OT (p < 0.05 for all). Severe chronic obstructive pulmonary disease, bleeding disorder, increasing age, and anesthesia time were associated with increased length of stay (p < 0.05). Preoperative dialysis dependence (odds ratio (OR), 8.5; 95% confidence interval (CI), 2.3-32.3) and dyspnea at rest (OR, 3.3; 95% CI, 1.7-6.3) were the greatest predictors of postoperative complications. Emergency case, bleeding disorder, prior percutaneous coronary intervention, and increasing operative time also were significantly associated with increased postoperative complications on multivariate logistic regression analysis (p < 0.05 for all). CONCLUSIONS: Age, sex, race, obesity, and some medical comorbidities affect outcomes and increase resource utilization. Optimization of modifiable factors and careful patient selection are needed to facilitate further improvement in outcomes and resource utilization.
Authors: Matthew M Hutter; Sheldon Randall; Shukri F Khuri; William G Henderson; William M Abbott; Andrew L Warshaw Journal: Ann Surg Date: 2006-05 Impact factor: 12.969
Authors: John J Kelly; Scott Shikora; Daniel B Jones; Matthew H Hutter; Malcolm K Robinson; John Romanelli; Frederick Buckley; Andrew Lederman; George L Blackburn; David Lautz Journal: Obesity (Silver Spring) Date: 2009-02-19 Impact factor: 5.002
Authors: Steven H Belle; Paul D Berk; Anita P Courcoulas; David R Flum; Carolyn W Miles; James E Mitchell; Walter J Pories; Bruce M Wolfe; Susan Z Yanovski Journal: Surg Obes Relat Dis Date: 2007 Mar-Apr Impact factor: 4.734
Authors: Nadia A Khan; Hude Quan; Jennifer M Bugar; Jane B Lemaire; Rollin Brant; William A Ghali Journal: J Gen Intern Med Date: 2006-02 Impact factor: 5.128
Authors: Jerome H Liu; David Zingmond; David A Etzioni; Jessica B O'Connell; Melinda A Maggard; Edward H Livingston; Carson D Liu; Clifford Y Ko Journal: Am Surg Date: 2003-10 Impact factor: 0.688
Authors: Robert N Cooney; Randy S Haluck; James Ku; Thomas Bass; Janelle MacLeod; Heather Brunner; Cynthia A Miller Journal: Obes Surg Date: 2003-02 Impact factor: 4.129
Authors: Paul Poirier; Martin A Alpert; Lee A Fleisher; Paul D Thompson; Harvey J Sugerman; Lora E Burke; Picard Marceau; Barry A Franklin Journal: Circulation Date: 2009-06-15 Impact factor: 29.690
Authors: Andrea Balla; Gabriela Batista Rodríguez; Santiago Corradetti; Carmen Balagué; Sonia Fernández-Ananín; Eduard M Targarona Journal: Langenbecks Arch Surg Date: 2017-08-05 Impact factor: 3.445
Authors: Jamii B St Julien; Melinda C Aldrich; Shubin Sheng; Stephen A Deppen; William R Burfeind; Joe B Putnam; Eric S Lambright; Jonathan C Nesbitt; Eric L Grogan Journal: Ann Thorac Surg Date: 2012-10-04 Impact factor: 4.330
Authors: Anne C Lambert-Kerzner; Davis M Aasen; Douglas M Overbey; Laura J Damschroder; William G Henderson; Karl E Hammermeister; Michael R Bronsert; Robert A Meguid Journal: J Thorac Dis Date: 2019-03 Impact factor: 2.895