Readmission rates following laparoscopic sleeve gastrectomy: Detailed analysis of 343 consecutive patients.

Amani Jambhekar, MD, Donald Risucci, PhD, Krystyna Kabata, PA, Anthony Tortolani, MD, Piotr Gorecki. NY Methodist Hospital

Background: Reported 30-day hospital readmission rates following bariatric surgery range from 0.7 to 16% depending upon type of surgery. The lowest readmission rates have been reported for Adjustable Gastric Bands (0.7 to 3.1%) whereas rates of 1.4 to 7.3% have been reported for laparoscopic Roux-en-Y Gastric Bypass. To date, one previous study has reported a 1.7% readmission rate for 529 Laparoscopic Sleeve Gastrectomies (LSG). The current report describes the incidence of 30-day readmission following primary LSG procedures performed at a single Bariatric Center of Excellence (COE) and examines factors that may be associated with readmission.

Methods: Data on 343 consecutive primary LSG operations performed between February 2010 and May 2014 by a single surgeon (PG), well experienced with other types of laparoscopic bariatric procedures, was analyzed. All data including complications and readmissions were collected and entered into a prospectively designed registry. COE clinical pathways were followed consistently for all patients. Patients readmitted within 30 days were compared to the remaining patients using Student t-tests for continuous variables and Chi-square tests for categorical variables.

Results: All LSG operations were completed laparoscopically with no conversions to open procedures. No open bariatric procedures were performed during the study period. There were no reoperations, leaks, or perioperative hemorrhages and no postoperative mortalities were reported. Twelve patients (3.5%) were readmitted; all resolved their presenting clinical problems with conservative management during readmission hospital stays of 1 – 7 days (mean = 3.5). One patient was readmitted twice. Reasons for readmission were abdominal pain (n=5), chest pain (n=3), vomiting with dehydration (n=3), shortness of breath (n=2), pancreatitis (n=1), portal vein thrombosis (n=1), and myocardial infarction (n=1). All readmitted patients were initially discharged home after 1-3 days of routine postoperative hospital stay (mean = 1.7). Readmissions occurred, on average, 15.9 days after surgery (range 4-30). Neither patient demographics (age, weight, BMI, race, sex, insurance status), comorbidities (type II diabetes, hypertension, obstructive sleep apnea, depression, arthritis), perioperative data (operating time, operative blood loss, intraoperative IV fluids, length of initial hospital stay), or other potential risk factors (preoperative serum CRP level, general well-being, total number of co-morbidities, number of abdominal surgeries in the past), had statistically significant association with readmission. Notably, seven (7%) readmissions occurred in the initial 100 patients and five (2%) in the remaining 243 patients (p= 0.04). Clinical pathways had been modified after the initial 100 patients; routine contrast radiograms were no longer performed and a one day routine postoperative stay was adopted in place of the prior two day routine. Operative time also decreased significantly from (Mean + SD) 94.2 + 23.8 to 78.2 + 20.0 minutes (p < 0.001).

Conclusions: Readmission rates following LSG remain in a similar range as described previously for other laparoscopic bariatric procedures. Increasing surgeon experience may result in further decrease of readmission rates following LSG. Larger, more detailed prospective studies are needed to determine the causes for readmission after LSG and to identify patterns of complications and causes for readmissions in LSG patients that may differ from other bariatric procedures.

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