Top

Surgical Endoscopy

Published in:

01-06-2016

Predictors of readmission after laparoscopic gastric bypass and sleeve gastrectomy: a comparative analysis of ACS-NSQIP database

Authors: Zhamak Khorgami, Amin Andalib, Ali Aminian, Matthew D. Kroh, Philip R. Schauer, Stacy A. Brethauer

Published in: Surgical Endoscopy | Issue 6/2016

Abstract

Background

Readmission rate is an indicator of quality in surgical practice. We aimed to determine the predictors of unplanned early readmissions following stapling bariatric surgeries.

Methods

From the American College of Surgeons National Surgical Quality Improvement Program database, we identified morbidly obese patients, who underwent either laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in 2012 and 2013. Demographic, comorbidities, operative and postoperative parameters of the readmitted (within 30 days) and non-readmitted patients were evaluated using a multivariate logistic regression analysis.

Results

A total of 35,655 patients (17,101 LSG and 18,554 LRYGB) were analyzed. Of those, 1758 patients (4.9 %) were readmitted within 30 days of surgery. Multivariate analysis showed the following significant predictors for readmission: Non-Hispanic black ethnicity (OR: 1.56, 95 % CI:1.34–1.81), Hispanic ethnicity (OR: 1.29, 95 % CI:1.05–1.58), totally or partially dependent functional status (OR: 1.94, 95 % CI:1.06–3.55), higher preoperative creatinine (OR: 1.13, 95 % CI:1.04–1.22), lower serum albumin (OR: 0.78, 95 % CI:0.68–0.90), diabetes mellitus on insulin (OR: 1.28, 95 % CI:1.09–1.51), steroid or immunosuppressant use for a chronic condition (OR: 1.61, 95 % CI:1.11–2.33), history of cardiac disease with intervention (OR: 2.05, 95 % CI:1.10–3.83), bleeding disorders (OR: 1.71, 95 % CI:1.15–2.54), LRYGB versus LSG (OR: 1.63, 95 % CI:1.44–1.85), longer operative time (OR: 1.13, 95 % CI:1.07–1.20), concurrent splenectomy (OR: 4.10, 95 % CI:1.05–16.01), and occurrence of any postoperative complication during index admission (OR: 2.61, 95 % CI:1.99–3.42).

Conclusions

Ethnicity, baseline functional status, comorbidities, type and duration of surgical procedure, and postoperative complications occurred in the index admission can predict risk of early readmission following LRYGB and LSG.

Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, Aminian A, Pothier CE, Kim ES, Nissen SE (2014) Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med 370(21):2002–2013CrossRefPubMed

Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737CrossRefPubMed

Brethauer SA, Aminian A, Romero-Talamás H, Batayyah E, Mackey J, Kennedy L, Kashyap SR, Kirwan JP, Rogula T, Kroh M (2013) can diabetes be surgically cured?: long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg 258(4):628PubMedPubMedCentral

Aminian A, Daigle CR, Romero-Talamás H, Kashyap SR, Kirwan JP, Brethauer SA, Schauer PR (2014) Risk prediction of complications of metabolic syndrome before and 6 years after gastric bypass. Surg Obes Relat Dis 10(4):576–582CrossRefPubMed

Encinosa WE, Bernard DM, Chen C-C, Steiner CA (2006) Healthcare utilization and outcomes after bariatric surgery. Med Care 44(8):706–712CrossRefPubMed

Centers for Medicare and Medicaid Services. “FY 2014 Hospital Readmissions Reduction Program Supplemental Data File.” Inpatient Prospective Payment System. http://www.cms.gov. Accessed 3 Feb 2015

National Quality Forum (2008) National Voluntary Consensus Standards for Hospital Care 2007: Performance Measures - A Consensus Report. National Quality Forum, Washington

111th United States Congress (2010) The Patient Protection and Affordable Care Act. http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/html/PLAW-111publ148.htm. Accessed 2 March 2015

Hansen LO, Young RS, Hinami K, Leung A, Williams MV (2011) Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 155(8):520–528CrossRefPubMed

10.

Dorman RB, Miller CJ, Leslie DB, Serrot FJ, Slusarek B, Buchwald H, Connett JE, Ikramuddin S (2012) Risk for hospital readmission following bariatric surgery. PLoS ONE 7(3):e32506. doi:10.1371/journal.pone.0032506 CrossRefPubMedPubMedCentral

11.

Saunders JK, Ballantyne GH, Belsley S, Stephens D, Trivedi A, Ewing DR, Iannace V, Capella RF, Wasielewski A, Moran S, Schmidt HJ (2007) 30-day readmission rates at a high volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass. Obes Surg 17(9):1171–1177CrossRefPubMed

12.

Telem DA, Talamini M, Gesten F, Patterson W, Peoples B, Gracia G, Yang J, Zhang Q, Altieri M, Pryor AD (2014) hospital admissions greater than 30 days following bariatric surgery: patient and procedure matter. Surg Endosc. doi:10.1007/s00464-014-3834-x PubMed

13.

Weller WE, Rosati C, Hannan EL (2007) Relationship between surgeon and hospital volume and readmission after bariatric operation. J Am Coll Surg 204(3):383–391CrossRefPubMed

14.

Nguyen NT, Masoomi H, Magno CP, Nguyen XM, Laugenour K, Lane J (2011) Trends in use of bariatric surgery, 2003–2008. J Am Coll Surg 213(2):261–266. doi:10.1016/j.jamcollsurg.2011.04.030 CrossRefPubMed

15.

American College of Surgeons ACS NSQIP Participant Use Data File. http://site.acsnsqip.org/participant-use-data-file. Accessed 28 Jan 2015

16.

American College of Surgeons User Guide for the 2013 ACS NSQIP Participant Use Data File (PUF). http://site.acsnsqip.org/wp-content/uploads/2014/11/ACS_NSQIP_PUF_User_Guide_2013.pdf. Accessed 9 Feb 2015

17.

Hong B, Stanley E, Reinhardt S, Panther K, Garren MJ, Gould JC (2012) Factors associated with readmission after laparoscopic gastric bypass surgery. Surg Obes Relat Dis 8(6):691–695CrossRefPubMed

18.

Kellogg TA, Swan T, Leslie DA, Buchwald H, Ikramuddin S (2009) Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass. Surg Obes Relat Dis 5(4):416–423CrossRefPubMed

19.

Abraham CR, Werter CR, Ata A, Hazimeh Y, Shah US, Bhakta A, Tafen M, Singh PT, Beyer TD, Stain SC (2015) Predictors of hospital readmission after bariatric surgery. J Am Coll Surg 221(1):220–227. doi:10.1016/j.jamcollsurg.2015.02.018 CrossRefPubMed

20.

Tayne S, Merrill CA, Shah SN, Kim J, Mackey WC (2014) Risk factors for 30-day readmissions and modifying postoperative care after gastric bypass surgery. J Am Coll Surg 219(3):489–495CrossRefPubMed

21.

Shelkrot M, Miraka J, Perez ME (2014) Appropriate enoxaparin dose for venous thromboembolism prophylaxis in patients with extreme obesity. Hosp Pharm 49(8):740–747. doi:10.1310/hpj4908-740 CrossRefPubMedPubMedCentral

22.

Merkow RP, Ju MH, Chung JW, Hall BL, Cohen ME, Williams MV, Tsai TC, Ko CY, Bilimoria KY (2015) Underlying reasons associated with hospital readmission following surgery in the United States. JAMA 313(5):483–495CrossRefPubMed

23.

Khorgami Z, Arheart KL, Zhang C, Messiah SE, de la Cruz-Muñoz N (2015) Effect of ethnicity on weight loss after bariatric surgery. Obes surg 25(5):769–776CrossRefPubMed

24.

Gupta PK, Ramanan B, Lynch TG, Sundaram A, MacTaggart JN, Gupta H, Fang X, Pipinos II (2012) Development and validation of a risk calculator for prediction of mortality after infrainguinal bypass surgery. J vasc surg 56(2):372–379CrossRefPubMedPubMedCentral

25.

Kariv Y, Wang W, Senagore AJ, Hammel JP, Fazio VW, Delaney CP (2006) Multivariable analysis of factors associated with hospital readmission after intestinal surgery. The Am J surg 191(3):364–371CrossRefPubMed

26.

Fonarow GC, Stevenson LW, Walden JA, Livingston NA, Steimle AE, Hamilton MA, Moriguchi J, Tillisch JH, Woo MA (1997) Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure. J Am Coll Cardiol 30(3):725–732CrossRefPubMed

27.

Aminian A, Brethauer SA, Sharafkhah M, Schauer PR (2015) Development of a sleeve gastrectomy risk calculator. Surg Obes Relat Dis 11(4):758–764CrossRefPubMed

28.

Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF (1999) Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the national va surgical risk study. Arch Surg 134(1):36–42CrossRefPubMed

29.

Kudsk KA, Tolley EA, DeWitt RC, Janu PG, Blackwell AP, Yeary S, King BK (2003) Preoperative albumin and surgical site identify surgical risk for major postoperative complications. JPEN J Parenter Enteral Nutr 27(1):1–9CrossRefPubMed

30.

Aminian A, Mirsharifi R, Karimian F, Khorgami Z, Nasiri S, Yazdankhah-Konari A, Alibakhshi A (2010) Influence of splenectomy on morbidity of esophageal cancer surgery. Scand J Surg 99(1):9–13PubMed

31.

Greenstein AJ, Wahed AS, Adeniji A, Courcoulas AP, Dakin G, Flum DR, Harrison V, Mitchell JE, O’Rourke R, Pomp A, Pender J, Ramanathan R, Wolfe BM (2012) Prevalence of adverse intraoperative events during obesity surgery and their sequelae. Journal of the American College of Surgeons 215 (2):271-277 e273. doi:10.1016/j.jamcollsurg.2012.03.008

32.

Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, Sadiraj V, Sweeney JF (2012) Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg 215(3):322–330. doi:10.1016/j.jamcollsurg.2012.05.024 CrossRefPubMedPubMedCentral

33.

Lawson EH, Hall BL, Louie R, Ettner SL, Zingmond DS, Han L, Rapp M, Ko CY (2013) Association between occurrence of a postoperative complication and readmission: implications for quality improvement and cost savings. Ann Surg 258(1):10–18. doi:10.1097/SLA.0b013e31828e3ac3 CrossRefPubMed

34.

Lawson EH, Hall BL, Louie R, Zingmond DS, Ko CY (2014) Identification of modifiable factors for reducing readmission after colectomy: a national analysis. Surgery 155(5):754–766. doi:10.1016/j.surg.2013.12.016 CrossRefPubMed

35.

Akutsu Y, Matsubara H (2009) Perioperative management for the prevention of postoperative pneumonia with esophageal surgery. Ann Thorac Cardiovasc Surg 15(5):280–285PubMed

36.

Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. The Cochrane database of systematic reviews (2):CD007635. doi:10.1002/14651858.CD007635.pub2

37.

Axon RN, Williams MV (2011) Hospital readmission as an accountability measure. JAMA 305(5):504–505CrossRefPubMed

38.

Sacks GD, Dawes AJ, Russell MM, Lin AY, Maggard-Gibbons M, Winograd D, Chung HR, Tomlinson J, Tillou A, Shew SB (2014) Evaluation of hospital readmissions in surgical patients: do administrative data tell the real story? JAMA surg 149(8):759–764CrossRefPubMed

Title: Predictors of readmission after laparoscopic gastric bypass and sleeve gastrectomy: a comparative analysis of ACS-NSQIP database
Authors: Zhamak Khorgami
Amin Andalib
Ali Aminian
Matthew D. Kroh
Philip R. Schauer
Stacy A. Brethauer
Publication date: 01-06-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 6/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4477-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictors of readmission after laparoscopic gastric bypass and sleeve gastrectomy: a comparative analysis of ACS-NSQIP database

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2016

Learning curve analysis of colorectal endoscopic submucosal dissection (ESD) for laterally spreading tumors by endoscopists experienced in gastric ESD

Laparoscopic common bile duct exploration using V-Loc suture with insertion of endobiliary stent

Endoscopic necrosectomy of walled-off pancreatic necrosis using a lumen-apposing metal stent and irrigation technique

Endoscopic mucosal resection of early oesophageal neoplasia in patients requiring anticoagulation: is it safe?

Laparoscopic deroofing for polycystic liver disease using laparoscopic fusion indocyanine green fluorescence imaging

Totally laparoscopic versus laparoscopic-assisted left colectomy for cancer: a retrospective review