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Readmissions following bariatric surgery benchmarked by procedure

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Results from the largest study to date examining the causes of hospital readmissions following bariatric surgery were presented at Obesity Week 2014.

“There are no benchmarking data for readmissions in the laparoscopic era; this data is needed so hospitals may compare their procedure-specific readmissions rates to national benchmarks and improve quality,” Ranjan Sudan, MD, vice chair of education, department of surgery at Duke University in Durham, N.C., told Endocrine Today. “Also, by understanding the most common causes for readmissions, clinical pathways or improvements in surgical technique can be implemented. Reducing readmissions will help reduce cost and further improve quality.”

Ranjan Sudan

Using data from the Bariatric Outcomes Longitudinal Database registry, Sudan and colleagues from other institutions looked at 282,478 patients who had Roux-en-Y gastric bypass (RYGB; n=173,081), adjustable gastric bands (AGB; n=74,260) and sleeve gastrectomies (SG; n=35,137) between June 2007 and March 2012 in Bariatric Surgery Centers of Excellence. The data came from 1,029 surgeons in 709 hospitals. All patients had a 30-day follow-up.

With approval from the American Society for Metabolic & Bariatric Surgery and Institutional Review Board, the researchers quantified and analyzed the rates and reasons for readmissions based on age, gender, race, baseline BMI and comorbidities. T-tests and chi-square tests were utilized where appropriate.

“The readmission rates for all bariatric procedures are in the range of 5% within 30 days,” Sudan said. “The rates are lowest for AGB, followed by sleeve gastrectomy and RYGB, respectively.”

Overall, 11,389 patients were readmitted. Nausea/vomiting was reported as a reason by 2,263 patients (24%), dehydration by 1,348 (14%), bleeding by 675 (6%), surgical infections by 656 (6%) and obstruction by 466 (5%). Most patients had undergone RYGB (79%), followed by AGB (11%) and SG (10%).

More readmissions were seen in patients with BMI >50 (34% vs. 29%), blacks (15% vs. 12%), length of stay >4 days (0.9% vs. 0.2%), hypertension (47% vs. 45%), diabetes (26% vs. 24%), lipids accompanying hypertension and diabetes (26% vs. 23%) and gastro esophageal reflux disease (24% vs. 20%). No differences were seen with age and gender.

“We need to develop clinical pathways and to manage nausea/vomiting and dehydration better, and this will help reduce readmission rates,” Sudan said. “Technical complications such as gastrointestinal bleeding and obstruction can be reduced with better technique.” — by Allegra Tiver

For More Information:

Sudan R. Abstract T-3087-OR. Presented at: Obesity Week; Nov 2-7, 2014; Boston.

Disclosures: Sudan reports no relevant financial disclosures.