Analysis of perioperative outcomes, length of hospital stay, and readmission rate after gastric bypass

Abstract

Background

Hospital lengths of stay (LOS) and readmission rates often are used by third parties to measure quality of outcomes despite only a few published series that analyze risk-adjusted data and predictors of these events.

Methods

Single-institution retrospective multivariable analysis of consecutive Roux-en-Y gastric bypass (RYGB) patients was performed to determine variables that may influence LOS and the readmission rate.

Results

Between 2006 and 2010, 1,065 consecutive RYGB procedures were analyzed. The mean initial body mass index (BMI) of the patients was 48.4 kg/m² (range 35–108 kg/m²), and their mean age was 42 years (range 15–75 years). Of these patients, 42% were black and 31% were either Medicare or Medicaid beneficiaries. The average LOS was 1.8 days (range 1–59 days; median, 2 days). The hospital discharged 48% of these patients on postoperative day (POD) 1, 85% on POD 2, and 96% on POD 3. According to multivariable Poisson regression, the independent predictors of a longer LOS included longer procedure time, surgeon, BMI, black race, older age, and status as a Medicare/Medicaid beneficiary (all P < 0.01). Gender and measured comorbidities were not associated with LOS. However, this model was poorly predictive of LOS due to substantial unexplained variance (R ² = 0.10). Complications were significantly associated with Medicare/Medicare status (odds ratio [OR] 2.0), older age (OR 1.03), and longer procedure time (OR 1.02) (P < 0.05). According to logistic regression, a 30-day readmission rate was predicted only by a LOS longer than 3 days for the primary procedure (P < 0.0005).

Conclusions

Early discharge on postoperative day 1 is possible but nonmodifiable, and random patient factors challenge predictable discharge planning. Reliable discharge on postoperative day 1 is not likely with current technologies.