Factors associated with readmission after laparoscopic gastric bypass surgery
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.