Factors associated with readmission after laparoscopic gastric bypass surgery
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.Surgery for Obesity and Related Diseases (Impact Factor: 4.07). 06/2011; 8(6). DOI: 10.1016/j.soard.2011.05.019
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: The increasing incidence of bariatric/metabolic surgery has brought concerns about the short- and long-term safety of this definitive treatment option. Many multicenter, large cohort studies of outcomes after bariatric surgery have been performed worldwide. Due to innovation in surgical methods and postoperative management programs in this field, there is a continuous improvement of outcomes related to safety. Many systemic and surgical complications after bariatric surgery have been reported, and late complications after gastric banding procedure are becoming issues as long-term follow-up studies are being performed. These databases utilize both clinical and administrative data methods. They may report in hospital only 30 or 90 day complication rates. Perioperative mortality in the past has been reported in as many as 1.5 to 2 % of bariatric surgical cases. Most recently this mortality has been reduced to 0.04-0.3 % from registries involving many thousands of patients. Complications are defined variably. Serious complications reportedly occur in 1-4 % of patients. In malabsorptive procedures, nutritional and micronutrient support is important because they frequently cause nutritional and metabolic problems long after surgery. Also, procedure-related complications such as intestinal obstruction and anastomotic stricture should be monitored after gastric bypass. This review refers to such adverse events which can threaten patient safety after bariatric surgery.Current Atherosclerosis Reports 10/2012; 14(6). DOI:10.1007/s11883-012-0287-3 · 3.42 Impact Factor
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ABSTRACT: The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.Surgery for Obesity and Related Diseases 03/2013; 9(2):159-91. DOI:10.1016/j.soard.2012.12.010 · 4.07 Impact Factor
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ABSTRACT: In 2012, Medicare began cutting reimbursement for hospitals with high readmission rates. We sought to define the incidence and risk factors associated with readmission after surgery. A total of 230,864 patients discharged after general, upper gastrointestinal (GI), small and large intestine, hepatopancreatobiliary (HPB), vascular, and thoracic surgery were identified using the 2011 American College of Surgeons National Surgical Quality Improvement Program. Readmission rates and patient characteristics were analyzed. A predictive model for readmission was developed among patients with length of stay (LOS) 10 days or fewer and then validated using separate samples. Median patient age was 56 years; 43% were male, and median American Society of Anesthesiologists (ASA) class was 2 (general surgery: 2; upper GI: 3; small and large intestine: 2; HPB: 3; vascular: 3; thoracic: 3; P < 0.001). The median LOS was 1 day (general surgery: 0; upper GI: 2; small and large intestine: 5; HPB: 6; vascular: 2; thoracic: 4; P < 0.001). Overall 30-day readmission was 7.8% (general surgery: 5.0%; upper GI: 6.9%; small and large intestine: 12.6%; HPB: 15.8%; vascular: 11.9%; thoracic: 11.1%; P < 0.001). Factors strongly associated with readmission included ASA class, albumin less than 3.5, diabetes, inpatient complications, nonelective surgery, discharge to a facility, and the LOS (all P < 0.001). On multivariate analysis, ASA class and the LOS remained most strongly associated with readmission. A simple integer-based score using ASA class and the LOS predicted risk of readmission (area under the receiver operator curve 0.702). Readmission among patients with the LOS 10 days or fewer occurs at an incidence of at least 5% to 16% across surgical subspecialties. A scoring system on the basis of ASA class and the LOS may help stratify readmission risk to target interventions.Annals of surgery 09/2013; 258(3):430-9. DOI:10.1097/SLA.0b013e3182a18fcc · 8.33 Impact Factor
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