Long-term Emergency Department Visits and Readmissions After Laparoscopic Roux-en-Y Gastric Bypass: a Systematic Review

Abstract

Purpose There is considerable evidence on short-term outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB), but data on long-term outcome is scarce, especially on postoperative emergency department (ED) visits and readmissions. We aim to systematically review evidence on the incidence, indications, and risk factors of ED visits and readmissions beyond 30 days after LRYGB. Materials and Methods A systematic search in PubMed, Scopus, Embase.com, Cochrane Library, and PsycINFO was performed. All studies reporting ED visits and readmissions > 30 days after LRYGB, with ≥ 50 patients, were included. PRISMA statement was used and the Newcastle-Ottawa Scale for quality assessment. Results Twenty articles were included. Six studies reported on ED visits (n = 2818) and 19 on readmissions (n = 276,543). The rate of patients with an ED visit within 90 days after surgery ranged from 3.9 to 32.6%. ED visits at 1, 2, and 3 years occurred in 25.6%, 30.0%, and 31.1% of patients. Readmissions within 90 days and at 1-year follow-up ranged from 4.1 to 20.5% and 4.75 to 16.6%, respectively. Readmission was 29% at 2 years and 23.9% at 4.2 years of follow-up. The most common reason for ED visits and readmissions was abdominal pain. Conclusion Emergency department visits and readmissions have been reported in up to almost one in three patients on the long-term after LRYGB. Both are mainly indicated for abdominal pain. The report on indications and risk factors is very concise. A better understanding of ED visits and readmissions after LRYGB is warranted to improve long-term care, in particular for patients with abdominal pains.

Lower survival and higher rates of cirrhosis in patients with ROUX-EN-Y gastric bypass hospitalised with alcohol-associated hepatitis

“… 13–15 However, long-term studies have shown that RYGB is also associated with gastrointestinal ulcers, dumping syndrome and chronic nutritional deficiencies, which can result in high rates of hospitalisations and the need for repeat surgery. 16–18 …”

“…RYGB results in significant loss of body weight, improvement of hepatic steatosis and can treat hypertension and type 2 DM 13–15. However, long-term studies have shown that RYGB is also associated with gastrointestinal ulcers, dumping syndrome and chronic nutritional deficiencies, which can result in high rates of hospitalisations and the need for repeat surgery 16–18…”

Pancreatic exocrine insufficiency after bariatric surgery

“…Bariatric surgery leads to considerable long-term weight loss and remission of obesity-related comorbidities with an acceptable low 30-day complication rate [3]. However, abdominal complaints are a common problem in the long term, leading to high numbers of emergency department visits, readmissions, and outpatient clinic visits [4]. Well-known causes include anastomotic ulcers, internal herniation, and gallstone disease [4].…”

“…However, abdominal complaints are a common problem in the long term, leading to high numbers of emergency department visits, readmissions, and outpatient clinic visits [4]. Well-known causes include anastomotic ulcers, internal herniation, and gallstone disease [4]. However, a significant part of chronic abdominal complaints after surgery remains unexplained [5,6].…”

Letter to the Editor

“…evidence and focus on abdominal pain after bariatric surgery [1]. In their systematic review, although incorporating limitations such as restricted long-term data availability, retrospective data, and data heterogeneity, they find indications of longterm emergency department visits and hospital admissions mostly for acute abdominal pain in close to one in three patients.…”