Abstract
Background
The objective of the study was to assess the risk factors associated with return to the operating room in bariatric surgery patients.
Methods
Using the American College of Surgeons-National Surgical Quality Improvement Project’s participant-use file, patients who underwent laparoscopic gastric bypass (LRYGB) and adjustable gastric band (LAGB) procedures for morbid obesity were identified. Several pre-, peri-, and postoperative variables, including 30 day morbidity and mortality, were collected. The study population was divided into two groups: patients returning to the operating room (group 1), and patients not returning to the operating room (group 2). Variables analyzed included postoperative complications, overall morbidity, and mortality. Relationships between preoperative and perioperative factors leading to the return to the operating room also were analyzed.
Results
Of 28,241 (LRYGB = 18,671, LAGB = 9,570) patients included in the study, 644 (2.3 %) patients returned to the operating room. Of the study population, 30 day mortality rate was 0.13 % (37/28,241) and morbidity was 4.1 % (1,155/28,241). Patients returning to the operating room had a higher mortality [14/644 (2.2 %) vs. 23/27,597 (0.01 %); P < 0.001], and morbidity [258/644 (40 %) vs. 897/27,579 (3.3 %); P < 0.001] compared with those who did not return to the operating room. Postoperative complications (superficial wound infection, deep surgical site infection, organ space infection, pneumonia, pulmonary embolism, renal insufficiency, renal failure, septic shock, and length of stay) were significantly higher for patients who required reoperation. On multivariate logistic regression analysis, the bypass operation, bleeding disorder, patients on dialysis, preoperative hematocrit, preoperative low albumin, and length of operation were associated with increased risk of return to the operating room.
Summary
In the bariatric population, return to the operating room is associated with significantly higher morbidity and mortality. Patients who are on dialysis, have a low preoperative serum albumin, and a history of bleeding disorders have a higher chance of return to the operating room. In addition, patients who have a long operation are at increased risk for return to the operating room. Increased awareness of these predictors will be helpful to counsel the patients before the operation.
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Acknowledgments
The American College of Surgeons National Surgical Quality Improvement Program 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.
Disclosures
Kalyana Nandipati, Edward Lin, Farah Husain, Sebastian Perez, Jahnavi Srinivasan, John F. Sweeney, and S. Scott Davis have no conflicts of interest or financial ties to disclose.
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Nandipati, K., Lin, E., Husain, F. et al. Factors predicting the increased risk for return to the operating room in bariatric patients: a NSQIP database study. Surg Endosc 27, 1172–1177 (2013). https://doi.org/10.1007/s00464-012-2571-2
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DOI: https://doi.org/10.1007/s00464-012-2571-2