Factors associated with readmission after laparoscopic gastric bypass surgery
ABSTRACT BACKGROUND: Studies have demonstrated that laparoscopic Roux-en-Y gastric bypass (RYGB) is associated with the greatest readmission rate among bariatric surgeries. Some readmissions might be avoidable. We sought to evaluate the risk factors for readmission in a high-volume bariatric surgery program at a university hospital in the United States. METHODS: We performed a retrospective review of prospectively maintained data. Patients readmitted within 30 days of laparoscopic RYGB were randomly matched to control patients who had undergone RYGB in the same year but were not readmitted. The readmissions were categorized as technical complications (leak), wound infections, or malaise (nausea, dehydration, or benign abdominal pain). Patients with a wound infection treated in an outpatient setting were also evaluated and compared with the patients admitted with a wound infection. RESULTS: From July 2002 to July 2008, 450 patients underwent RYGB. Readmission occurred in 42 patients (9%). Of these 42 patients, 6 were admitted with wound infections (14%), 18 (43%) with malaise, and 18 (43%) with technical complications. The patients admitted with wound infections were similar to their controls, except that they were more likely to have publicly funded insurance (Medicare or Medicaid) and more likely to present for medical attention to the emergency department after clinic hours. The patients admitted with malaise reported a greater pain score at discharge and were also more likely to have public health insurance than controls. The patients with technical complications did not differ from the control patients in any examined variable. CONCLUSIONS: Patients with publicly funded insurance are at increased risk of readmission after RYGB. Outpatient mechanisms for managing wound infections and malaise might result in decreased readmissions.
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ABSTRACT: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a complex procedure performed in a patient population with significant medical comorbidities. Evaluation and modification of surgical techniques can minimize the complications associated with the lengthy learning curve for this procedure. The purpose of this study was to evaluate a single surgeon's decade-long experience with LRYGB, to determine whether complications decreased with experience and surgical modifications improved perioperative outcomes. A retrospective review of all procedures performed by a fellowship-trained surgeon (MK) from December 1, 2000, to October 31, 2013, identified patients who underwent LRYGB. We evaluated perioperative outcomes in 1117 patients and examined the impact of modification of surgical techniques on complications. The patients were divided into 4 groups: cases 1-100 (group 1), cases 101-400 (group 2), cases 401-700 (group 3), and cases 701-1117 (group 4). Operating time decreased significantly after the initial 100 cases, from 179.1 minutes for group 1 to 122.1 minutes for group 4. With experience, early complication rates improved from 25.0% to 5.0%, but the rates of early reoperation increased from 1.0% to 2.2% over the 4 case groups. Late complication and reoperation rates increased from 4.0% to 10.5%. However, rates of bleeding, early stricture, internal hernia, and wound infection all decreased after the modification of surgical techniques. Operating time and early complication rates decreased with operative experience, but late complication and early and late reoperation rates increased. However, after modifications of surgical technique, common complications of LRYGB decreased to rates lower than those reported in several gastric bypass case series in the literature. The findings in this study will be helpful to fellow bariatric surgeons who are refining their strategies for reducing morbidity related to LRGYB.01/2015; 19(1). DOI:10.4293/JSLS.2014.00256
- Surgery for Obesity and Related Diseases 05/2014; DOI:10.1016/j.soard.2014.02.034 · 4.94 Impact Factor
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ABSTRACT: Background Hospital readmissions have come under increasing scrutiny as they are costly and thought to represent poor healthcare-quality. Evaluation of surgical readmissions following hospitalization is still in its infancy and lacks summative analysis. Therefore, we determine the current state of knowledge regarding hospital readmissions following general and vascular surgery. Methods A literature search was performed utilizing PubMed from January 1, 2009 to July 1, 2013 to identify articles related to hospital readmissions following vascular, general, bariatric, and colorectal surgical procedures. The following endpoints were evaluated: readmission rates and diagnoses, predictors of readmission, and mortality in readmitted patients. Results An initial literature search (2009-2013) yielded 619 articles. After systematic application of exclusion criteria, 39 articles remained (vascular=10, general=8, bariatric=5, colorectal=16). The 30-day median readmission rate for vascular surgery was 18.5% (n=9, range: [8.9,24.4%]); general surgery: 9.7% (n=5, range: [5.3,12.1%]); bariatric surgery: 6.8% (n=5, range: [3.7,9.3%]); and colorectal surgery: 12.8% (n=13, range: [8.3,32.5%]). The most frequently reported readmission diagnosis was wound complication amongst all specialties. The most commonly reported predictor of readmission was prolonged length of stay. In only one article each was a risk prediction model or a prospective intervention to prevent readmission reported. In the studies where long-term mortality was measured, there was a marked association between readmission and long-term mortality. Conclusions Early readmissions are common across surgical specialties, providing the impetus to improve our understanding of causes and consequences. Efforts should focus on standardizing definitions, creating prediction tools and designing interventions that specifically address readmission in the surgical population.Journal of the American College of Surgeons 09/2014; DOI:10.1016/j.jamcollsurg.2014.05.007 · 4.45 Impact Factor