Highlights
- •A total of 569,652 patients were readmitted with racial group and procedure predictive of all-cause readmission (Table 3). Non-Hispanic Black [OR 1.52; 95% CI: 1.47-1.58] or Hispanic [OR 1.14; 95% CI: 1.09-1.19] were more likely to be readmitted when compared to non-Hispanic White adults.
- •LSG [odds ratio (OR) 1.27; 95% confidence interval (CI): 1.10-1.48] and RYGB (OR 2.24; 95% CI: 1.93-2.60) were associated with readmission compared to LAGB. Robotic approach increased from 6.2% in 2015 to 9.8% in 2018 (p<0.0001). LOS > 3 days occurred in 2.9% of laparoscopic procedures vs 3.2% of robotic procedures (P=0.001). The rate of readmission was 3.7% for laparoscopy and 4.3% for robotic surgeries (P<0.0001).
- •Men comprised < 22% of the total cohort every year. Men, especially Black men, were more likely to present with a BMI ≥ 50kg/m2 compared to women. Interestingly, male gender was protective for readmission (OR 0.87; 95% CI: 0.84-0.90]. It is critical to understand that Black patients, in particular Black men, experience a prolonged LOS more often than White patients.
- •Further investigation into the intersectionality of race and gender would provide a better understanding of disparities in access and outcomes for bariatric surgery patients. Future studies should review the effects of enhanced recovery protocols across racial groups to better understand readmission after bariatric surgery.
Abstract
Background
Readmission after bariatric surgery is multifactorial. Understanding the trends in
risk factors for readmission provides opportunity to optimize patients prior to surgery
identify disparities in care, and improve outcomes.
Objectives
This study compares trends in bariatric surgery as they relate to risk factors for
all-cause readmission.
Setting
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)
participating facilities.
Methods
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program
database was used to analyze 760,076 bariatric cases from 854 centers. Demographics
and 30-day unadjusted outcomes were compared between laparoscopic adjustable gastric
banding (LAGB), sleeve gastrectomy (LSG), and Roux-en-Y gastric bypass (RYGB) performed
between 2015 and 2018. A multiple logistic regression model determined predictors
of readmission.
Results
A total of 574,453 bariatric cases met criteria, and all-cause readmission rates decreased
from 4.2% in 2015 to 3.5% in 2018 (P < .0001). The percentage of non-Hispanic Black adults who underwent bariatric surgery
increased from 16.7% of the total cohort in 2015 to 18.7% in 2018 (P < .0001). The percentage of Hispanic adults increased from 12.1% in 2015 to 13.8%
in 2018 (P < .0001). The most common procedure performed was the LSG (71.5%), followed by RYGB
(26.9%) and 1.6% LAGB (1.6%) (P < .0001). Men were protected from readmission compared with women (odds ratio [OR]:
.87; 95% confidence interval [CI]: .84–.90). Non-Hispanic Black (OR: 1.52; 95% CI:
1.47–1.58)] and Hispanic adults (OR: 1.14; 95% CI: 1.09–1.19) were more likely to
be readmitted compared with non-Hispanic White adults. LSG (OR: 1.27; 95% CI: 1.10–1.48)
and RYGB (OR: 2.24; 95% CI: 1.93–2.60) were predictive of readmission compared with
LAGB.
Conclusion
Readmission rates decreased over 4 years. Women, along with non-Hispanic Black and
Hispanic adults, were more likely to be readmitted. Future research should focus on
gender and racial disparities that impact readmission.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Surgery for Obesity and Related DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- National prevalence, causes, and risk factors for bariatric surgery readmissions.Am J Surg. 2016; 212: 76-80
- Hospital readmissions reduction program.Circulation. 2015; 131: 1796-1803
- Prevalence and risk factors for bariatric surgery readmissions.Ann Surg. 2018; 267: 122-131
- Early hospital readmission after bariatric surgery.Surg Endosc. 2016; 30: 2231-2238
- Predictors of hospital readmission after bariatric surgery.J Am Coll Surg. 2015; 221: 220-227
- National trends in bariatric surgery 2012–2015: demographics, procedure selection, readmissions, and cost.Obes Surg. 2017; 27: 2933-2939
- Predictors of readmission after laparoscopic gastric bypass and sleeve gastrectomy: a comparative analysis of ACS-NSQIP database.Surg Endosc. 2016; 30: 2342-2350
- Trends in bariatric surgery from 2008 to 2012.Am J Surg. 2016; 211: 1041-1046
- Influence of ethnicity on the efficacy and utilization of bariatric surgery in the USA.J Gastrointest Surg. 2014; 18: 130-136
- Characterizing readmissions after bariatric surgery.J Gastrointest Surg. 2016; 20: 1797-1801
- American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States.Surg Obes Relat Dis. 2020; 16: 457-463
- Evaluating organizational factors associated with postoperative bariatric surgery readmissions.Surg Obes Relat Dis. 2017; 13: 1004-1009
- Outcomes in conventional laparoscopic versus robotic-assisted primary bariatric surgery: a retrospective, case–controlled study of the MBSAQIP database.Surg Endosc. 2020; 34: 1353-1365
- Underlying reasons associated with hospital readmission following surgery in the United States.JAMA. 2015; 313: 483-495
- Assessment of postdischarge complications after bariatric surgery: a National Surgical Quality Improvement Program analysis.Surgery. 2015; 158: 777-786
- Emergency department visits and readmissions within 1 year of bariatric surgery: a statewide analysis using hospital discharge records.Surgery. 2017; 162: 1155-1162
- The first metabolic and bariatric surgery accreditation and quality improvement program quality initiative: decreasing readmissions through opportunities provided.Surg Obes Relat Dis. 2014; 10: 377-378
- Employing Enhanced Recovery Goals in Bariatric Surgery (ENERGY): a national quality improvement project using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.Surg Obes Relat Dis. 2019; 15: 1977-1989
- The relationship between duration of stay and readmissions in patients undergoing bariatric surgery.Surgery. 2015; 158: 501-507
- Physiologic and psychological gender differences in bariatric surgery.Surg Endosc. 2018; 32: 1382-1388
- Obesity in America.Surg Obes Relat Dis. 2017; 13: 1643-1650
- Perceived health risk of excess body weight among overweight and obese men and women: differences by sex.Prev Med. 2008; 47: 46-52
- Risk for hospital readmission following bariatric surgery.PLoS One. 2012; 7e32506
- Racial disparities in perioperative outcomes after bariatric surgery.Surg Obes Relat Dis. 2019; 15: 786-793
- Disparity in access to bariatric surgery among African-American men.Surg Endosc. 2020; 34: 2630-2637
- A challenge between trainee education and patient safety: does fellow participation impact postoperative outcomes following bariatric surgery?.Obes Surg. 2016; 26: 1999-2005
- Does fellow participation in laparoscopic Roux-en-Y gastric bypass affect perioperative outcomes?.Surg Endosc. 2012; 26: 3442-3448
- Roux-en-Y gastric bypass procedure performed with the da Vinci robot system: is it worth it?.Surg Endosc. 2008; 22: 1690-1696
- Robot-assisted sleeve gastrectomy for super-morbidly obese patients.J Laparoendosc Adv Surg Tech A. 2011; 21: 295-299
- Robotically assisted bariatric surgery.Am J Surg. 2004; 188: 38S-44S
- Robotic gastric bypass may lead to fewer complications compared with laparoscopy.Surg Endosc. 2018; 32: 610-616
- Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass.Surg Obes Relat Dis. 2005; 1: 549-554
- Robotic-assisted Roux-en-Y gastric bypass performed in a community hospital setting: the future of bariatric surgery?.Surg Endosc. 2011; 25: 3312-3321
- Totally robotic laparoscopic Roux-en-Y gastric bypass: results from 75 patients.Obes Surg. 2006; 16: 690-696
- Surgical skill and complication rates after bariatric surgery.N Engl J Med. 2013; 369: 1434-1442
Article info
Publication history
Published online: January 06, 2022
Accepted:
December 30,
2021
Received:
August 15,
2021
Identification
Copyright
© 2022 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Comment on: Trends in risk factors for readmission after bariatric surgery 2015–2018Surgery for Obesity and Related DiseasesVol. 18Issue 5
- PreviewIn 2021, bariatric surgery is the most effective treatment for obesity and its related co-morbidities. Despite objective advances in safety [1] and rapid growth in the number of eligible patients, surgical treatment continues to be viewed as the option of last resort by many physicians and nonphysicians alike, with only 0.5% of eligible patients undergoing a bariatric operation in 2016 [2].
- Full-Text
- Preview
