Characterizing Readmissions After Bariatric Surgery

Garg, Trit; Rosas, Ulysses S.; Rogan, Daniel T.; Hines, Harrison; Rivas, Homero; Morton, John M.; Azagury, Dan E.

doi:10.1007/s11605-016-3247-3

Cited by 24 publications

(20 citation statements)

References 21 publications

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“…This is in accordance with previously published series [6, 7, 15]. The 1-year and 6-year all-cause admissions rates were 21.4% and 65.9%, respectively.…”

Section: Discussionsupporting

confidence: 93%

Hospital admission after gastric bypass: a nationwide cohort study with up to 6 years follow-up

Bruze

Ottosson

Neovius

et al. 2017

Surgery for Obesity and Related Diseases

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BACKGROUND Several studies have addressed short-term admission rates after bariatric surgery. However, studies on long-term admission rates are few and population based studies are even scarcer. OBJECTIVE The aim of this study was to assess short and long-term admission rates for gastrointestinal surgery after gastric bypass in Sweden compared to admission rates in the general population. SETTING Swedish healthcare system. METHODS The surgery cohort consisted of adults with Body Mass Index (BMI) ≥35 identified in the Scandinavian Obesity Surgery Registry (SOReg; n=28,331; mean age 41y; 76% women; Roux-en-Y gastric bypass performed 2007–2012). For each individual, up to 10 comparators from the general population were matched on birth year, sex, and place of residence (n=274,513). The primary outcome was inpatient admissions due to gastrointestinal surgery retrieved from the National Patient Register through December 31, 2014. Conditional hazard ratios (HR) were estimated using Cox regression. RESULTS All-cause admission rates were 6.5%, 21.4% and 65.9% during 30d, 1, and 6 years after surgery. The corresponding rates for gastrointestinal surgery were 1.8%, 6.8%, and 24.4%. Compared to the general population, there was an increased risk of all-cause hospital admission at 1 year (HR 2.6 [2.5–2.6]) and 6 years (HR 2.7 [2.6–2.7]). The risk of hospital admission for any gastrointestinal surgical procedure was greatly increased throughout the study period (HR 8.6 [8.4–8.9]). Female sex, psychiatric disease, and low education were risk factors. CONCLUSION We found a significant risk of admission to hospital over more than 6 years after gastric bypass surgery.

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“…This is in accordance with previously published series [6, 7, 15]. The 1-year and 6-year all-cause admissions rates were 21.4% and 65.9%, respectively.…”

Section: Discussionsupporting

confidence: 93%

Hospital admission after gastric bypass: a nationwide cohort study with up to 6 years follow-up

Bruze

Ottosson

Neovius

et al. 2017

Surgery for Obesity and Related Diseases

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“…According to other studies, patient-related factors associated with prolonged LOS were age, higher preoperative BMI, male sex, number of preoperative comorbidities, and operative time [ 18 , 35 – 38 ]. Regarding demographic factors in our study, they were not significantly related to the risk of prolonged LOS.…”

Section: Discussionmentioning

confidence: 99%

“…In numerous papers, we found significant correlations of some patient-dependent factors and comorbidities on readmission rates, i.e., higher BMI and ASA class, diabetes mellitus, cardio-vascular, respiratory, renal co-morbidities, and chronic steroid intake, protein malnutrition were showed to be associated with increased risk of readmission [ 21 , 25 , 34 , 35 , 38 , 39 ]. Treating patients in accordance to ERAS protocol probably contributed to non-significant relationship of preoperative ASA class and comorbidities with the risk of postoperative readmissions in our study [ 6 , 7 , 15 , 16 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Prolonged Length of Hospital Stay and Readmissions After Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass

Major

Wysocki

Torbicz³

et al. 2017

OBES SURG

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BackgroundLaparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB) are most commonly performed bariatric procedures. Laparoscopic approach and enhanced recovery after surgery (ERAS) protocols managed to decrease length of hospital and morbidity. However, there are patients in whom, despite adherence to the protocol, the length of stay (LOS) remains longer than targeted. This study aimed to assess potential risk factors for prolonged LOS and readmissions.MethodsThe study was a prospective observation with a post-hoc analysis of bariatric patients in a tertiary referral university teaching hospital. Inclusion criteria were undergoing laparoscopic bariatric surgery. Exclusion criteria were occurrence of perioperative complications, prior bariatric procedures, and lack of necessary data. The primary endpoints were the evaluations of risk factors for prolonged LOS and readmissions.ResultsMedian LOS was 3 (2–4) days. LOS > 3 days occurred in 145 (29.47%) patients, 79 after LSG (25.82%) and 66 after LRYGB (35.48%; p = 0.008). Factors significantly prolonging LOS were low oral fluid intake, high intravenous volume of fluids administered on POD0, and every additional 50 km distance from habitual residence to bariatric center. The risk of hospital readmission rises with occurrence of intraoperative adverse events and low oral fluid intake on the day of surgery on.ConclusionsRisk factors for prolonged LOS are low oral fluid intake, high intravenous volume of fluids administered on POD0, and every additional 50 km distance from habitual residence. Risk factors for hospital readmission are intraoperative adverse events and low oral fluid intake on the day of surgery.

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“…Readmission may be more likely to occur within the first few weeks after surgery for LSG patients compared to LRYGB patients; nevertheless, LRYGB should be followed closely within the first 3 months to manage potential complications that would require readmission [ 38 ]. There was no statistically significant difference in incidence of readmissions among our patients.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Care and Functional Recovery After Laparoscopic Sleeve Gastrectomy vs. Laparoscopic Roux-en-Y Gastric Bypass Among Patients Under ERAS Protocol

Major

Stefura²,

Małczak

et al. 2017

OBES SURG

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BackgroundThe most commonly performed bariatric procedures are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). There are major differences between LSG and LRYGB during postoperative period. Optimization of the postoperative care may be achieved by using enhanced recovery after surgery (ERAS) protocol, which allows earlier functional recovery.PurposeThe aim was to assess differences in the course of postoperative care conducted in accordance with ERAS protocol among patients after LSG and LRYGB.Material and MethodsData concerning patients treated for morbid obesity were prospectively gathered in one academic center. Patients were divided into two groups: LSG (n = 364, 63.41%) and LRYGB (n = 210, 36.59%). Multiple factors were used as endpoints to determine the influence of the type of bariatric procedure on postoperative course.ResultsThe rate of postoperative nausea and vomiting and incidence of intravenous fluid administration during the operation was higher in LSG group. LRYGB patients were able to tolerate higher oral fluid intake volumes during the first and the second postoperative day. Mean diuresis during the second and the third postoperative day was significantly higher in LRYGB group. Administration of diuretics and painkillers was comparable between groups, while the risk of fever after the operation was higher in LRYGB group. Mean length of stay was higher in LSG group (LRYGB vs. LSG, 3.46 days ± 1.58 vs. 3.64 days ± 4.41, p = 0.039).ConclusionsIn our opinion, postoperative treatment after LSG requires more supervision and longer time until functional recovery is achieved.

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Characterizing Readmissions After Bariatric Surgery

Abstract: Readmissions after bariatric surgery are associated with high index hospital LOS, and a measureable proportion of procedure-related readmissions can occur up to 1 year, especially for LRYGB.

Cited by 24 publications

References 21 publications

Hospital admission after gastric bypass: a nationwide cohort study with up to 6 years follow-up

Hospital admission after gastric bypass: a nationwide cohort study with up to 6 years follow-up

Risk Factors for Prolonged Length of Hospital Stay and Readmissions After Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass

Postoperative Care and Functional Recovery After Laparoscopic Sleeve Gastrectomy vs. Laparoscopic Roux-en-Y Gastric Bypass Among Patients Under ERAS Protocol

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