THIRTY-DAY READMISSION AFTER BARIATRIC SURGERY: CAUSES, EFFECTS ON OUTCOMES AND PREDICTORS.
Pedro Palacios Argueta*1, Miguel Salazar1, John J. Vargo2, John Rodriguez2, Prabhleen Chahal2, Christopher C. Thompson3, C. Roberto Simons-Linares2
1Cook County Health & Hospital System (CCHHS), Chicago, IL; 2Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH; 3Brigham & Women's Hospital / Harvard Medical School, Boston, MA
Background: Bariatric surgery is one of the most common surgical procedures in North America. Hospital readmissions have a high burden to the health care system. We aim to identify the main causes of readmission and the predictors after bariatric surgery (BSx) and its effect on outcomes.
Methods: Cohort study using the 2016 National Readmission Database (NRD) of adult patients readmitted to the hospital after an index admission for bariatric surgery. ICD-10CM/PCS codes were used to identify patients who underwent bariatric surgery, other comorbidities and procedures. We identified the most common causes of readmission and independent risk factors for readmission were identified using Cox regression analysis.
Results: A total of 166,540 patients had an index admission for bariatric surgery, out of which 4.3% (n=8,154) were readmitted within 30 days of discharge. The top three causes for readmission were dehydration, sepsis and post-surgical infection.
Readmitted patients were more likely to be male (34.1% vs 24.9%;P<0.01), older (53.1 vs. 47.6 years; P<0.01) to have Medicare (36.5% vs. 21.5%P<0.01) as primary payer, to be from the lowest median income zip code (28.6% vs. 25.5%; P<0.01), to develop shock (1.3% vs. 0.5%; P<0.01), to be from large bed size hospitals (1.19; P=0.02), from lower quintile of hospital volume (63.0 % vs. 57.1%;P<0.01), to have diabetes type 1 (DM1) (1.1% vs. 0.4%; P<0.01), CKD (9.1% vs. 3.6%; P<0.01) history of alcohol abuse (1.5% vs. 0.9%;P<0.01), history of opioid abuse (1.1% vs. 0.4%; P<0.01), history of cannabis use (0.6% vs. 0.2% P<0.01), to be more likely to require peripheral parenteral nutrition (PPN) (2.0% vs. 0.8%; P<0.01) and central parenteral nutrition (CPN) (4.0% vs. 1.1%; P<0.01). Readmitted patients were less likely to require mechanical ventilation (1.3% vs. 1.9%; P=0.01), to have history of NASH (0.4% vs. 1.1%; P<0.01), low vitamin D (2.4% vs. 6.6%; P<0.01) .
Readmission was associated with higher in-hospital mortality rate (2.6% vs. 0.8%; P<0.01) and longer hospital length of stay (5.4 vs. 3.7 days; P<0.01). A total of 44,187 days were associated with readmission and the total economic burden of readmission was $398 million in total charges and $99 million in total costs. Independent predictors of readmission were age [HR 1.00; P=0.01], LOS [HR 1.01; P<0.01], being discharge from large bed size hospitals [HR 1.19; P=0.02], index admission PPN [HR1.26; P=0.03], CPN [HR1.48; P=0.01], having DM1 [HR1.85; P<0.01], history of opioid abuse [HR1.55; P=0.01] and CKD [HR1.52; P<0.01].
Conclusion: Readmissions after bariatric surgery are associated with higher in-hospital mortality and pose a very high health care burden. We have identified risk factors, many of them that are modifiable and they can be targeted to alleviate this burden and decrease patient morbidity and mortality.
Table 1: Patient Characteristics
Table 2: Predictors of Readmission
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