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Obesity Week 2013

Study identifies readmission risk factors for bariatric surgery

Gallstones and a history of DVT may be the most clinically significant

Bariatric surgery readmission rates are relatively low in a patient population with significant comorbidities, compared to other elective surgery populations, according to researchers from Duke University. They reported that most of the

co-morbidities collected in their prospective database did not increase the risk of readmission.

The study authors noted that readmission after bariatric surgery increases expenses and contributes to patient morbidity. However, knowing the risk factors for readmission may help prevent such occurrences, so they attempted to identify the risk factors so they could predict which patients are likely to be readmitted 30 days after discharge from bariatric surgery.

They performed a retrospective review of all bariatric surgeries at their institution and categorised by operation (RYGB, sleeve gastrectomy, adjustable gastric banding (AGB), biliopancreatic diversion with duodenal switch (BPD/DS), or revisional surgery.

Readmission within 30 days of discharge, patient’s age, sex, BMI, hospital length of stay (LOS), operative duration, and 31 different co-morbidities identified for the Bariatric Outcomes Longitudinal Database (BOLD) were collected.

Readmitted patients were compared to patients not readmitted using multivariate analysis.

The outcomes showed that  in 4.3, they performed 3,146 bariatric procedures (61.8% RYGB, 9.7% sleeve gastrectomy, 15.6% AGB, 2.4% BPD/DS, and 5.6% revisional surgery) with a total of 152 (4.8%) documented readmissions within 30 days of discharge.

The readmission rates across the different procedures were statistically significant (p=0.04) with the individual rates being 8.8% for revisional surgery, 7.3% BPD/DS, 4.8% RYGB, 4.3% AGB, and 3.2% sleeve gastrectomy.

Age, length of stay and BMI were not significantly different for patients with re-admissions, although length of surgery was significantly increased in patients who were readmitted (131± 77 minutes vs. 116± 60 minutes, p=0.002).

Risk factors for increased admission rates included male gender (p=0.008), preoperative history of DVT (p<0.001), preoperative documentation of gallstones (p<0.001), a preoperative history of musculoskeletal disease (p<0.001), a diagnosis of fibromyalgia (p=0.001), diagnosis of gastro-oesophageal reflux disease (GERD) (p=0.017), and preoperative symptoms of back pain (p=0.022).

Duration of surgery, sex, history of DVT, preoperative gallstones, musculoskeletal disease, and fibromyalgia remained statistically significant after multivariate logistical regression analysis

“Of those that we identified as being a risk factor for readmission, gallstones and a history of DVT may be the most clinically significant,” said the researchers. “A change in the perioperative care of patients with gallstones or a history of DVT may have the potential to further decrease readmission rates.”

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