INCIDENCE, BURDEN AND PREDICTORS OF ONE-YEAR READMISSION IN PATIENTS UNDERGOING BARIATRIC SURGERY
Pedro Palacios Argueta*3,2, Miguel Salazar1, Paul T. Kröner2, Frank Lukens2, C. Roberto Simons-Linares1
1Cleveland Clinic, Cleveland, OH; 2Mayo Clinic's Campus in Florida, Jacksonville, FL; 3Cook County, Chicago, IL
Background
30-40% of Americans suffer from obesity. Bariatric surgery (BSx) is one of the most common surgical procedures performed in the United States. There is a knowledge gap regarding readmissions for patients that undergo BSx.
Methods
Retrospective cohort study using the 2016 National Readmission Database. Adult patients admitted for BSx in January were included. The follow up period was 11 months (February-December). The primary outcome was readmission of any cause. Secondary outcomes were mortality and resource utilization (length of stay (LOS), total hospitalization costs and charges) associated with readmission. Independent risk factors for readmission were identified using Cox regression analysis.
Results
13,674 index admissions were included. Mean age was 47.0 years and 76.3% of patients were female. The 11-month readmission rate was 11.7% (n=1,617). The mortality rate of readmission was 3.6% and 0.9% for the index admission (IA) (P<0.01). The three most common causes of readmission were: 1) hematemesis, 2) sepsis and 3) sepsis due to staphylococcus. Patients that were readmitted were more likely to be older (51.2 years vs. 46.4 years; P<0.01), to have Roux-N-Y Bypass Surgery (RYGB) (41.8% vs. 29.9%; P<0.01), Charlson Comorbidity Index Score (CCI) '‰¥3 (21.4% vs. 8.4%; P<0.01). They were less likely to be female (68.9% vs. 77.3%; P<0.01), to have body mass index (BMI) between 40-44 kg/m2 (23.9%vs. 28.4%;P<0.01), to have private insurance as primary payer (45% vs. 60.1%; P<0.01), to be from the 5th quintile of hospital volume (56.1% vs. 60.1; P<0.01), to have vitamin D deficiency (3.7% vs. 6.5%;P<0.01). The mean LOS, total hospitalization charges and costs for readmission was 4.1 days, $44,546 and $11,251, respectively. The cumulative total hospitalization charges of readmission were $69.9 million. Independent predictors were CCI score '‰¥3 (adjusted Hazard Ratio [aHR] 1.46; P<0.01), prolonged LOS (aHR 1.02; P<0.01), transfer to rehabilitation facilities (aHR 5.37; P<0.01), undergoing any sleeve gastrectomy (SG) (aHR 12.03; P<0.01), open adjustable gastric band (AGB) (aHR 12.45; P<0.01) and cannabis use disorder (CUD) (aHR 3.37; P=0.01). Private insurance as primary payer (aHR 0.66; P<0.01), residence in micropolitan areas (aHR 0.43; P=0.01), requiring parenteral nutrition during IA (aHR 0.43-0.20-0.90; P=0.02), vitamin D deficiency (aHR 0.64; 0.43-0.95), BMI between 45-49 kg/m2 (aHR 0.72; P=0.01) were associated with less risk of readmission.
Conclusion
The 11-month all cause readmission risk for patients undergoing BSx is 11.7%. Readmission is associated with higher significant mortality and with significant resource utilization. Targeting modifiable risk factors such as CUD could help reduce the burden of readmissions on our health care system.
Predictors of readmission
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