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Factors implicated in discharge disposition following elective bariatric surgery

Published:September 02, 2020DOI:https://doi.org/10.1016/j.soard.2020.08.031

      Highlights

      • ACF discharge is rare and comprises less than 1% of all MBSAQIP cases
      • Functional status was the single greatest modifiable predictor of ACF discharge
      • Pneumonias and cardiac complications were the greatest post-operative predictors of ACF discharge
      • Selection of surgical candidates should emphasize a patient-centered functional approach

      Abstract

      Background

      Current bariatric surgery studies have focused on traditional outcomes such as mortality and morbidity and have thus far have neglected an important marker of surgical care- discharge destination.

      Objectives

      The aim of this study was to 1) characterize the prevalence of and clinical characteristics of patients who undergo bariatric surgery with respect to discharge disposition and to 2) evaluate factors which predict alternate care facility (ACF) discharge.

      Setting

      Participating Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) centers.

      Methods

      Data was extracted from the MBSAQIP data registry from 2015 to 2018. All primary Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures were included while prior revisional surgeries and emergency surgeries were excluded. Our primary objective was to characterize the prevalence of and clinical characteristics of patients who undergo bariatric surgery and are discharged to an alternate care facility (ACF). Our secondary outcome was to identify predictors of discharge to an ACF using multivariable logistic regression modeling.

      Results

      Most patients (n = 588,256; 99.6%) were discharged home while only a small proportion were discharged to an ACF (n = 1502; .4%). Patients discharged to an ACF were older (51.5 ± 13.5 yr versus 44.4 ± 12.0 yr; P < .0001), of increased body mass index (49.7 ± 11.9 kg/m2 versus 45.3 ± 7.8 kg/m2; P < .0001), and more likely to be of male sex (26.8% versus 20.4%; P < .0001). Patients with hypertension (65.2% versus 47.9%; P < .0001), dyslipidemia (40.1% versus 23.7%; P < .0001), sleep apnea (52.7% versus 38.1%; P < .0001), and medication-dependent diabetes (39.5% versus 26.3%; P < .0001) were more likely to be discharged to an ACF. Multivariable logistic regression revealed that partially dependent and dependent functional status were the single greatest preoperative predictors of ACF discharge with an 8- and 7-fold respective increase in odds of ACF versus patients of independent functional status.

      Conclusion

      Impaired functional status was the single greatest independent preoperative predictor of ACF discharge, providing evidence against the current use of a strict age cut-off criteria and support for implementation of a more patient-centered functional approach in selection of surgical candidates.

      Key words

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      Linked Article

      • Comments on: Factors implicated in discharge disposition following elective bariatric surgery
        Surgery for Obesity and Related DiseasesVol. 17Issue 1
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          I read with interest the manuscript entitled "Factors Implicated in Discharge Disposition Following Elective Bariatric Surgery" by Mocanu et al. [1], in which most patients left home safely after bariatric surgery (99.6%) but 4 of 1000 did not. They departed to an alternate care facility. As we expected, most of these patients were elderly males with a higher body mass index (BMI) and may present associated co-morbidities like hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, and so forth.
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