Factors Influencing 30-Day Emergency Visits and Readmissions after Sleeve Gastrectomy: Results from a Community Bariatric Center
- 305 Downloads
- 8 Citations
Abstract
Introduction
Bariatric surgery has proven safe and effective for long-term weight loss in morbidly obese patients. Readmissions within 30 days of discharge have become an important metric for quality of care. Sleeve gastrectomy is a common bariatric procedure, but data regarding early readmission is sparse. The purpose of this study is to determine what, if any, demographic or technical factors influence returns to the hospital or readmission following sleeve gastrectomy.
Methods
All laparoscopic sleeve gastrectomies (n = 200) performed at a single community hospital from February 2009 to November 2012 were retrospectively reviewed. Demographic, technical, length of stay, return to Emergency Department (ED) and readmission data were gathered for each patient. The data were analyzed to determine what factors were related to early return to the Emergency Department or readmission.
Results
Demographics were similar to other studies, with a male to female ratio of 1:4. Patients returning to the ED or readmitted within 30 days were statistically younger than those not returning. None of the other demographic, social, technical, or comorbid conditions considered were associated with a statistically significant risk of readmission or return to the ED within 30 days.
Conclusion
Although the only statistically significant difference among the groups studied was age, trends toward significance exist in minority ethnicity and comorbid asthma. These factors have been associated with increased complications in other types of surgery. Larger, multi-institutional studies are needed to further evaluate these and other risk factors for readmission following bariatric surgery.
Keywords
Bariatric surgery Sleeve gastrectomy Readmission Patient discharge Patient readmission Risk factors Length of stayNotes
Conflict of Interest
Dr. Lutfi is a consultant for Ethicon, GORE, and Allergan. Dr. Willson, Dr. Gomberawalla, and Ms. Mahoney declare that they have no conflict of interest.
References
- 1.Nguyen NT et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279–89. discussion 289-91.CrossRefPubMedCentralPubMedGoogle Scholar
- 2.Ballantyne GH et al. Predictors of prolonged hospital stay following open and laparoscopic gastric bypass for morbid obesity: body mass index, length of surgery, sleep apnea, asthma, and the metabolic syndrome. Obes Surg. 2004;14(8):1042–50.CrossRefPubMedGoogle Scholar
- 3.Dallal RM, Datta T, Braitman LE. Medicare and Medicaid status predicts prolonged length of stay after bariatric surgery. Surg Obes Relat Dis. 2007;3(6):592–6.CrossRefPubMedGoogle Scholar
- 4.Fares 2nd LG et al. 23-Hour stay outcomes for laparoscopic Roux-en-Y gastric bypass in a small, teaching community hospital. Am Surg. 2008;74(12):1206–10.PubMedGoogle Scholar
- 5.dos Santos Moraes Jr I et al. Hospital discharge in the day following open Roux-en-Y gastric bypass: is it feasible and safe? Obes Surg. 2009;19(3):281–6.CrossRefPubMedGoogle Scholar
- 6.Dallal RM, Trang A. Analysis of perioperative outcomes, length of hospital stay, and readmission rate after gastric bypass. Surg Endosc. 2012;26(3):754–8.CrossRefPubMedGoogle Scholar
- 7.Cooney RN et al. The impact of a clinical pathway for gastric bypass surgery on resource utilization. J Surg Res. 2001;98(2):97–101.CrossRefPubMedGoogle Scholar
- 8.Huerta S et al. Reduced length of stay by implementation of a clinical pathway for bariatric surgery in an academic health care center. Am Surg. 2001;67(12):1128–35.PubMedGoogle Scholar
- 9.Sasse KC et al. Outpatient weight loss surgery: initiating a gastric bypass and gastric banding ambulatory weight loss surgery center. JSLS. 2009;13(1):50–5.PubMedCentralPubMedGoogle Scholar
- 10.Dorman RB et al. Risk for hospital readmission following bariatric surgery. PLoS One. 2012;7(3):e32506.CrossRefPubMedCentralPubMedGoogle Scholar
- 11.Hong B et al. Factors associated with readmission after laparoscopic gastric bypass surgery. Surg Obes Relat Dis. 2012;8(6):691–5.CrossRefPubMedGoogle Scholar
- 12.Kellogg TA et al. Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(4):416–23.CrossRefPubMedGoogle Scholar
- 13.Stellato TA et al. Two-day length of stay following open Roux-en-Y gastric bypass: is it feasible, safe and reasonable? Obes Surg. 2004;14(1):27–34.CrossRefPubMedGoogle Scholar
- 14.Pratt GM et al. Demographics and outcomes at American Society for Metabolic and Bariatric Surgery Centers of Excellence. Surg Endosc. 2009;23(4):795–9.CrossRefPubMedGoogle Scholar
- 15.Pratt GM, McLees B, Pories WJ. The ASBS Bariatric Surgery Centers of Excellence program: a blueprint for quality improvement. Surg Obes Relat Dis. 2006;2(5):497–503. discussion 503.CrossRefPubMedGoogle Scholar
- 16.McCarty TM et al. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242(4):494–8. discussion 498-501.PubMedCentralPubMedGoogle Scholar
- 17.Watkins BM et al. Adjustable gastric banding in an ambulatory surgery center. Obes Surg. 2005;15(7):1045–9.CrossRefPubMedGoogle Scholar
- 18.Kormanova K et al. Is laparoscopic adjustable gastric banding a day surgery procedure? Obes Surg. 2004;14(9):1237–40.CrossRefPubMedGoogle Scholar
- 19.Lemanu DP et al. Randomized clinical trial of enhanced recovery versus standard care after laparoscopic sleeve gastrectomy. Br J Surg. 2013;100(4):482–9.CrossRefPubMedGoogle Scholar
- 20.Awad S et al. Enhanced recovery after bariatric surgery (ERABS): clinical outcomes from a tertiary referral bariatric centre. Obes Surg. 2014;24(5):753–8.CrossRefPubMedCentralPubMedGoogle Scholar
- 21.Dailey EA et al. Risk factors for readmission of orthopaedic surgical patients. J Bone Joint Surg Am. 2013;95(11):1012–9.CrossRefPubMedGoogle Scholar
- 22.Hannan EL et al. Predictors of readmission for complications of coronary artery bypass graft surgery. JAMA. 2003;290(6):773–80.CrossRefPubMedGoogle Scholar
- 23.Iannuzzi JC et al. Risk score for unplanned vascular readmissions. J Vasc Surg. 2014;59(5):1340–7. e1.CrossRefPubMedGoogle Scholar
- 24.Baker MT et al. Length of stay and impact on readmission rates after laparoscopic gastric bypass. Surg Obes Relat Dis. 2006;2(4):435–9.CrossRefPubMedGoogle Scholar
- 25.Yeats M et al. The use and modification of clinical pathways to achieve specific outcomes in bariatric surgery. Am Surg. 2005;71(2):152–4.PubMedGoogle Scholar
- 26.Weller WE, Rosati C, Hannan EL. Relationship between surgeon and hospital volume and readmission after bariatric operation. J Am Coll Surg. 2007;204(3):383–91.CrossRefPubMedGoogle Scholar