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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Article info
Publication history
Published online: September 02, 2020
Accepted:
August 19,
2020
Received:
July 28,
2020
Identification
Copyright
© 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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- Comments on: Factors implicated in discharge disposition following elective bariatric surgerySurgery for Obesity and Related DiseasesVol. 17Issue 1
- PreviewI 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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