A. W. Lois1, M. J. Frelich1, N. Sahr2, S. F. Hohmann3, T. Wang2, J. C. Gould1 1Medical College Of Wisconsin,General Surgery,Milwaukee, WI, USA 2Medical College Of Wisconsin,Biostatistics,Milwaukee, WI, USA 3University HealthSystem Consortium,Comparative Data & Informatics Research,Chicago, IL, USA
Introduction: Readmissions are a potential quality metric in bariatric surgery. A readmission substantially increases the cost of a bariatric operation. In the current era of laparoscopic surgery, bariatric surgery patients are being discharged early, sometimes within 1 day of surgery. Early discharge has been implicated as a possible cause of early readmission. We hypothesized that early discharge following bariatric surgery is not associated with an increased rate of readmission.
Methods: The University Health System Consortium (UHC) is an alliance of academic medical centers and 244 affiliated hospitals. The database contains information on inpatient stay up to 30 days post-discharge. A multicenter analysis of patient outcomes was performed using the 5-year discharge data from December 2008 to December 2013 for patients 18 years and older. Patient data was collected using procedure codes for gastric bypass, laparoscopic adjustable gastric band, and laparoscopic sleeve gastrectomy. All procedures were restricted by diagnosis codes for morbid obesity.
Results: A total of 95,294 patients met inclusion criteria. The mean age of the study population was 45.4 (±0.11) years and 73,941 (77.6%) subjects were female. The most common procedure was gastric bypass (58,036; 60.9%), followed by sleeve gastrectomy (26,669; 28.0%), and gastric banding (10,589; 11.1%). There were a total of 5,423 (5.7%) readmissions. Readmission rates were 6.3% for gastric bypass, 5.6% for sleeve gastrectomy, and 2.7% for gastric banding (p<0.01). Complications were experienced in 1.1% of gastric bypass, 1.3% of sleeve gastrectomy, and 0.3% of gastric banding procedures (p<0.01). An increasing number of comorbid conditions and increasing number of complications were both independently associated with higher rate of readmission on logistic regression (p<0.01, p<0.01).
Conclusion: Early discharge from the hospital following bariatric surgery does not appear to be associated with an increased rate of readmissions. In fact, we observed the opposite effect with patients staying longer at the index admission more likely to be readmitted within 30 days. Hospitals capable of efficiently discharging patients sooner may have other factors favoring a lower likelihood of readmission (surgeon experience, standardized pathways) not discernable from the current data. Complications, gastric bypass, and comorbidities are also associated with an increased risk of readmission. Targeted interventions for patients with specific risk factors for readmission (early clinic visit for patients experiencing complications on the index admission for example) may be an effective strategy for reducing readmissions after bariatric surgery.
