Jerry T Dang, BSc, MD1, Noah J Switzer, BSc, MD1, Xinzhe Shi, MPH2, Chris de Gara, MB, MS, FRCS, Ed, Eng, C, FACS2, Daniel W Birch, MSc, MD, FRCSC, FACS2, Shahzeer Karmali, MPH, MD, FRCSC, FACS2. 1Department of Surgery, University of Alberta, 2Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital
INTRODUCTION: The objective of this study was to determine readmission rates after primary bariatric surgery in a publicly-funded, comprehensive bariatric center and determine predictive factors associated with readmission. Previous studies looking into readmission have found rates ranging anywhere from 0.6 to 11.3%. Another study found that length of stay greater than two days and any complication during the initial admission were associated with readmission. Given the high volume of bariatric surgery performed at our center and excellent follow-up rates, we wanted to analyze our readmission rates following bariatric surgery and determine factors that predict early readmission.
METHODS AND PROCEDURES: A population-based cohort study was performed on all patients undergoing primary bariatric surgery from January 2010 to December 2015 in a publicly-funded, comprehensive bariatric center. Procedures included laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric band (LAGB). Data were collected from an administrative database. Multivariate regression analysis was then performed to determine factors that predict 30-day readmission.
RESULTS: Over five years, 1469 patients had primary bariatric surgery (51.0% LRYGB, 40.4% LSG, 8.6% LAGB) with an overall 30-day readmission rate of 7.49%. The mean length of stay (LOS) for readmissions was 5.3 days and readmissions stays of 4 days or less accounted for 70% of the cohort. The majority of patients (67.9%) were admitted early, within the first 10 days from discharge. LRYGB had a higher readmission rate (11.3%) compared with LSG (3.9%) or LAGB (1.6%). The most common admitting diagnoses for readmission were infectious complications (24.8%), pain (17.4%), nausea/vomiting (10.1%), bleeding (9.2%), obstruction (6.4%) and anastomotic ulcers (5.5%). A significant amount of readmissions were found to have venous thromboembolisms (5.2%).
Multivariate logistic regression analysis found three factors that were independently predictive of readmission: initial LOS greater than four days (OR 2.56, 95% CI 1.31 to 5.00, p = 0.006), LRYGB (OR 5.92, 95% CI 1.28 to 27.45, p = 0.023) and acute renal failure (OR 19.67, 95% CI 1.16 to 332.80, p = 0.039).
CONCLUSIONS: The rate of readmission after bariatric surgery in our center is 7.49%. Patients with LOS greater than four days, acute renal failure and LRYGB procedures were at higher risk of readmission. Given these findings, strategies such as the prevention of acute renal failure and closer outpatient follow-up in higher risk patients may reduce the frequency of readmissions.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79151
Program Number: P506
Presentation Session: Poster (Non CME)
Presentation Type: Poster