Arturo J Rios-Diaz1, David Metcalfe2, Courtney L Devin3, Adam Berger3, Francesco Palazzo3. 1. Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA. Electronic address: arturo.riosdiaz@jefferson.edu. 2. University of Oxford, John Radcliffe Hospital, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford, United Kingdom. 3. Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Abstract
BACKGROUND: Morbidity and mortality after laparoscopic bariatric surgery have decreased steadily during the past 2 decades. National data on the rates at which these patients may require return to the hospital beyond 30 days are lacking. We aimed to determine the national burden and causes of readmission after the 3 most common bariatric procedures in the United States. METHODS: All adult patients with morbid obesity (>18 years old) who underwent a laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, or laparoscopic gastric bypass between 2010 and 2015 were identified using International Classification of Diseases, Ninth Revision codes from the Nationwide Readmission Database. The Nationwide Readmission Database permits longitudinal tracking of patients between hospital admissions and allows for nationally weighted estimates. The primary outcome was 180-day readmission; secondary outcomes included causes, mortality, time to readmission, costs, and procedures during readmission. Multivariate logistic regression models were used to determine factors associated with increased 180-day readmission after adjusting for differences in patient and hospital characteristics. RESULTS: Records from 228,043 patients were identified, of whom 10.1%, 36.1%, and 53.9% underwent laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass, respectively. The overall 180-day readmission rate was 10.8% (laparoscopic adjustable gastric banding 8.3%, LGS 7.8% and laparoscopic gastric bypass 13.2%). Readmission analysis showed that 64.5% were directly relates directly to the index procedure, 31.2% were readmitted to a different hospital, the median time to readmission was 28 days (interquartile ratio 9-77), 23.9% had a gastrointestinal procedure, and 0.48% died within the 180-day readmissions. Factors independently associated with increased readmission were the following: greater preoperative comorbidities (Charlson Comorbidity Index ≥2, odds ratio 1.32; 95% confidence interval, 1.22-1.44); either Medicare status (1.84 [1.72-1.97]) or Medicaid status (1.60 [1.48-1.73]) relative to private insurance; moderate (1.09 [1.03-1.15]) or major (1.33 [1.13-1.56]) severity of illness relative to minor Nationwide Readmission Database-provided severity of illness; nonresident of state where they were admitted initially (1.49 [1.31-1.69]); discharge to a health care system other than home (1.70 [1.46-1.97]); short-term hospital 1.70 [1.46-1.97]); admission to private hospital (1.11 [1.01-1.22]) relative to nonprofit hospital; prolonged duration of initial hospital stay (1.81 [1.70-1.92]); and a serious adverse event occurring during the index admission (1.20 [1.02-1.42]). Patients who were readmitted had an incremental mean difference of $15,781 (95% confidence interval, $15,168-$16,394.4; P < .001) in total costs. CONCLUSION: Readmissions after bariatric surgery continue to occur even 6 months after discharge. Most of these readmissions were related directly to the index procedure. Almost a fourth of those patients who were readmitted d required a procedure and almost a third presented to a different hospital than the hiatal of their initial operation. These readmissions carry a substantial burden for the health care system and may impair quality of life for patients. Strategies targeted to prevent readmissions beyond the traditional 30-day benchmark are warranted in this population.
BACKGROUND: Morbidity and mortality after laparoscopic bariatric surgery have decreased steadily during the past 2 decades. National data on the rates at which these patients may require return to the hospital beyond 30 days are lacking. We aimed to determine the national burden and causes of readmission after the 3 most common bariatric procedures in the United States. METHODS: All adult patients with morbid obesity (>18 years old) who underwent a laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, or laparoscopic gastric bypass between 2010 and 2015 were identified using International Classification of Diseases, Ninth Revision codes from the Nationwide Readmission Database. The Nationwide Readmission Database permits longitudinal tracking of patients between hospital admissions and allows for nationally weighted estimates. The primary outcome was 180-day readmission; secondary outcomes included causes, mortality, time to readmission, costs, and procedures during readmission. Multivariate logistic regression models were used to determine factors associated with increased 180-day readmission after adjusting for differences in patient and hospital characteristics. RESULTS: Records from 228,043 patients were identified, of whom 10.1%, 36.1%, and 53.9% underwent laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass, respectively. The overall 180-day readmission rate was 10.8% (laparoscopic adjustable gastric banding 8.3%, LGS 7.8% and laparoscopic gastric bypass 13.2%). Readmission analysis showed that 64.5% were directly relates directly to the index procedure, 31.2% were readmitted to a different hospital, the median time to readmission was 28 days (interquartile ratio 9-77), 23.9% had a gastrointestinal procedure, and 0.48% died within the 180-day readmissions. Factors independently associated with increased readmission were the following: greater preoperative comorbidities (Charlson Comorbidity Index ≥2, odds ratio 1.32; 95% confidence interval, 1.22-1.44); either Medicare status (1.84 [1.72-1.97]) or Medicaid status (1.60 [1.48-1.73]) relative to private insurance; moderate (1.09 [1.03-1.15]) or major (1.33 [1.13-1.56]) severity of illness relative to minor Nationwide Readmission Database-provided severity of illness; nonresident of state where they were admitted initially (1.49 [1.31-1.69]); discharge to a health care system other than home (1.70 [1.46-1.97]); short-term hospital 1.70 [1.46-1.97]); admission to private hospital (1.11 [1.01-1.22]) relative to nonprofit hospital; prolonged duration of initial hospital stay (1.81 [1.70-1.92]); and a serious adverse event occurring during the index admission (1.20 [1.02-1.42]). Patients who were readmitted had an incremental mean difference of $15,781 (95% confidence interval, $15,168-$16,394.4; P < .001) in total costs. CONCLUSION: Readmissions after bariatric surgery continue to occur even 6 months after discharge. Most of these readmissions were related directly to the index procedure. Almost a fourth of those patients who were readmitted d required a procedure and almost a third presented to a different hospital than the hiatal of their initial operation. These readmissions carry a substantial burden for the health care system and may impair quality of life for patients. Strategies targeted to prevent readmissions beyond the traditional 30-day benchmark are warranted in this population.
Authors: Jean-Eric Tarride; Aristithes G Doumouras; Dennis Hong; J Michael Paterson; Semra Tibebu; Richard Perez; Julia Ma; Valerie H Taylor; Feng Xie; Vanessa Boudreau; Eleanor Pullenayegum; David R Urbach; Mehran Anvari Journal: JAMA Surg Date: 2020-09-16 Impact factor: 14.766
Authors: Jacqueline A Murtha; Dillon C Svoboda; Natalie Liu; Morgan K Johnson; Manasa Venkatesh; Jacob A Greenberg; Anne O Lidor; Luke M Funk Journal: J Laparoendosc Adv Surg Tech A Date: 2021-07-12 Impact factor: 1.766