Early Readmission After Laparoscopic Roux-en-Y Gastric Bypass

Camille D Blackledge, MD, Aerin DeRussy, MPH, Allison Gullick, MSPH, Richard Stahl, MD, Jayleen Grams, MD, PhD. The University of Alabama at Birmingham

Background: Bariatric surgery has emerged as an effective and durable treatment for obesity and obesity-related comorbidities. Postoperative readmissions result in an increase in overall cost and are increasingly being used as a benchmark for quality of care. The purpose of this study was to examine the risk factors associated with and reasons for readmission following laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods: An Institutional Review Board-approved retrospective review was conducted of all patients undergoing LRYGB at a single institution between 2005 and 2013. Data analyzed included preoperative demographics and clinical status and 30- and 90-day hospital readmission. Readmission was divided into early readmission at ≤30 days post procedure, and late readmissions at 31-90 days post discharge. Summary Z-Scores were used as a proxy for socioeconomic status when individual characteristics were unavailable. Univariate and bivariate frequencies were used to describe population characteristics and factors associated with readmissions. Chi-square tests were used to determine differences among categorical variables and the Wilcoxon Rank Sums test was used to determine differences among continuous variables. 

Results:  Of the 652 patients who underwent LRYGB during the study period, the overall rate of readmission was 4.4 %. Eleven patients had 12 early readmissions, and 15 patients had 17 additional readmissions at 90 days. There were no statistically significant differences in demographics, socioeconomic status, geographical distance, or clinical status between the patients who were readmitted and those who were not. The reasons for readmission are included below. The diagnoses associated with early readmissions included undetermined (33.3%), anastomotic complications (33.3%), other GI etiology [small bowel obstruction, portal vein thrombosis, GI bleeding (25%)], and pneumonia (8.3%). The diagnoses associated with late readmissions included anastomotic complications (52.9%), undetermined etiology (17.6%), disease unrelated to bariatric surgery (17.6%), and biliary complications (11.8%).

Conclusion: No significant risk factors were associated with readmission after bariatric surgery. Post discharge nausea, vomiting, and abdominal pain were the most common reasons for readmission following LRYGB. These symptoms were of an undetermined etiology during the early postoperative period and indicated anastomotic complications in the late postoperative period. Our results suggest GI symptoms are the most common reason for readmission after bariatric surgery. Efforts to improve education both preoperatively and at discharge may reduce early readmissions after LRYGB.  

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