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Determinants of resource utilization and outcomes in laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of 14,251 patients

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Abstract

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.

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Disclosures

Dr. Prateek K Gupta, Mr. Weldon Miller, Ms. Jyothsna Sainath, and Dr. R. Armour Forse have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Creighton University Medical Center, Omaha, NE, 68131, USA

    Prateek K. Gupta & R. Armour Forse

  2. University of Virginia, Charlottesville, VA, USA

    Weldon J. Miller

  3. Department of Statistics, University of Nebraska, Lincoln, NE, USA

    Jyothsna Sainath

Authors
  1. Prateek K. Gupta
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  2. Weldon J. Miller
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  3. Jyothsna Sainath
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  4. R. Armour Forse
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Correspondence to R. Armour Forse.

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ACS NSQIP Disclaimer: The ACS NSQIP and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. This study does not represent the views or plans of the ACS or the ACS NSQIP.

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Gupta, P.K., Miller, W.J., Sainath, J. et al. Determinants of resource utilization and outcomes in laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of 14,251 patients. Surg Endosc 25, 2613–2625 (2011). https://doi.org/10.1007/s00464-011-1612-6

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