Six-month readmissions after bariatric surgery: Results of a nationwide analysis

Rios-Diaz, Arturo J.; Metcalfe, David; Devin, Courtney L.; Berger, Adam C.; Palazzo, Francesco

doi:10.1016/j.surg.2019.06.003

Cited by 24 publications

(15 citation statements)

References 17 publications

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“…However, other studies have also shown a risk for surgical complications following bariatric surgery. 26 Our data also suggest that overall, patients who received bariatric surgery prior to kidney transplantation have similar patient or allograft survival compared with those who did not receive bariatric surgery. Recipients of sleeve gastrectomy had lower risk of graft failure compared to those who did not undergo bariatric surgery.…”

Section: -Day Readmission Following Kidney Transplantation In Those Withsupporting

confidence: 62%

“…We did find a tendency toward higher odds of 30‐day readmission following kidney transplantation in those with Roux‐en‐Y and laparoscopic banding, and the most common reason for readmissions was surgical‐related complications, although this finding did not consistently achieve statistical significance. However, other studies have also shown a risk for surgical complications following bariatric surgery 26 …”

Section: Discussionmentioning

confidence: 99%

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Bariatric surgery prior to transplantation and risk of early hospital re-admission, graft failure, or death following kidney transplantation

McCulloch

Roll

et al. 2021

American Journal of Transplantation

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Although obesity is a known risk factor for morbidity in the general population, there has been significant controversy over the optimal weight for patients with end-stage kidney disease (ESKD). [1][2][3][4][5][6] Weight loss prior to kidney transplantation could potentially reduce the risk of postoperative complications and delayed graft function, and improve survival. 7-9 However, for many dialysis patients, weight loss is challenging to achieve. [7][8][9] With advances in bariatric surgery techniques, there has been an increase in bariatric surgery rates among Medicare patients with ESKD. 10 Recent studies have demonstrated a strong association between bariatric surgery and improved access to kidney transplantation in severely obese dialysis patients. 11,12 The objective of this study was to determine whether performance of bariatric surgery prior to transplantation in severely obese patients receiving dialysis is associated with benefits after

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Section: -Day Readmission Following Kidney Transplantation In Those Withsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Bariatric surgery prior to transplantation and risk of early hospital re-admission, graft failure, or death following kidney transplantation

McCulloch

Roll

et al. 2021

American Journal of Transplantation

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“…Wood et al reported significantly higher rate of overall complications at 30 days in Black patients than in white patients. 20 Several studies found higher rates in readmissions among black patients as well as the publicly insured and those in lower income quartiles [18][19][20][21][22][23]30 Some studies have also reported increase in overall complications and no difference in mortality, 21 increase in mortality but no difference in complications, 22 and others have reported no racial differences and postoperative adverse effects. 23,31 This study's focus on LRYGB, despite a trend away from LRYGB in favor of sleeve gastrectomy in the United States, 19,30 is a matter of both clinical and statistical consideration.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, a reason for sleeve gastrectomy's growing popularity is its low complication rate 19 ; it has a better safety profile in the first 30 days postoperatively than LRYGB. 32 Bariatric surgery in general already has low complication rates, 18 and so there were too few complications in the index admission compared with all sleeve gastrectomies performed to make a statistically sound argument. The data used from the NIS in our study has inherent limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that Medicaid or Medicare insurance status, relative to commercial private insurance, was independently associated with readmission after bariatric surgery. 18 Others have found that African American patients were likely to have the longest length of hospital stays, highest complication rates, and least weight loss. 2 19 20 21 22 23 However, the majority of these analyses use 30-day readmission to assess complication rates.…”

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confidence: 99%

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The Effect of Social Determinants and Socioeconomic Status on Laparoscopic Roux-En-Y Gastric Bypass for Weight Loss: An Analysis of the National Inpatient Sample

et al. 2021

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Objective In the United States, Black and Hispanic patients have a higher prevalence of obesity than Whites (49.6 vs. 44.8 vs. 42.2%, respectively). Despite higher rates of obesity among minority populations, bariatric surgery is performed at higher obesity levels in minorities than in Whites. This study examines the effects of various socioeconomic factors such as race, payer type, and income on the likelihood of undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) at class II versus class III obesity and their associated complications. Materials and Methods National Inpatient Sample (NIS) from 2016 to 2017 was queried to identify patients at least 18 years of age with a concomitant diagnosis of class II or class III obesity who underwent LRYGB. We analyzed obesity level at the time of LRYGB (class II vs. class III), postoperative intestinal obstruction during the admission, and occurrence of any noninfectious complication related to the surgery as our main outcomes. A multivariate logistic regression model was utilized to assess the association between our outcomes and socioeconomic factors associated with the admission. Results A total of 76,405 LRYGB operations were included. Out of this total, 83% (63,640) LRYGB operations were in class III obesity. Black patients had a lower rate (11.6%) of LRYGB procedures at class II obesity than White (17.6%) and Hispanic (18%) patients (p < 0.001). Medicare, Medicaid, and lower income quartiles also showed lower rates of operation at class II obesity (p < 0.001). Black patients were 29% (95% confidence interval [CI]: 0.61–0.83, p < 0.001) less likely than Whites to have a LRYGB procedure at class II obesity, they were 119% (95% CI: 1.17–4.11, p = 0.0014) more likely to suffer a postoperative intestinal obstruction, and they were 93% (95% CI: 1.31–2.84, p < 0.001) more likely to suffer a noninfectious complication. Conclusion Socioeconomic disparities in the surgical management of severe obesity persist in the United States, especially for LRYGB. This study highlights multiple demographic factors that led to LRYGB at later obesity levels. Black patients were also more likely to be associated with postoperative complications during the admission. The determinants of health disparities in obese patients need to be examined further to reduce potential long-term morbidity and mortality in minorities. Further research is also required to identify the adverse effects of health disparities in patients with severe obesity and obesity-related comorbidities.

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National Estimates of Short- and Longer-Term Hospital Readmissions After Major Surgery Among Community-Living Older Adults

Wang,

Leo-Summers,

Vander Wyk

et al. 2024

JAMA Netw Open

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ImportanceNationally representative estimates of hospital readmissions within 30 and 180 days after major surgery, including both fee-for-service and Medicare Advantage beneficiaries, are lacking.ObjectivesTo provide population-based estimates of hospital readmission within 30 and 180 days after major surgery in community-living older US residents and examine whether these estimates differ according to key demographic, surgical, and geriatric characteristics.Design, Setting, and ParticipantsA prospective longitudinal cohort study of National Health and Aging Trends Study data (calendar years 2011-2018), linked to records from the Centers for Medicare &amp; Medicaid Services (CMS). Data analysis was conducted from April to August 2023. Participants included community-living US residents of the contiguous US aged 65 years or older who had at least 1 major surgery from 2011 to 2018. Data analysis was conducted from April 10 to August 28, 2023.Main Outcomes and MeasuresMajor operations and hospital readmissions within 30 and 180 days were identified through data linkages with CMS files that included both fee-for-service and Medicare Advantage beneficiaries. Data on frailty and dementia were obtained from the annual National Health and Aging Trends Study assessments.ResultsA total of 1780 major operations (representing 9 556 171 survey-weighted operations nationally) were identified from 1477 community-living participants; mean (SD) age was 79.5 (7.0) years, with 56% being female. The weighted rates of hospital readmission were 11.6% (95% CI, 9.8%-13.6%) for 30 days and 27.6% (95% CI, 24.7%-30.7%) for 180 days. The highest readmission rates within 180 days were observed among participants aged 90 years or older (36.8%; 95% CI, 28.3%-46.3%), those undergoing vascular surgery (45.8%; 95% CI, 37.7%-54.1%), and persons with frailty (36.9%; 95% CI, 30.8%-43.5%) or probable dementia (39.0%; 95% CI, 30.7%-48.1%). In age- and sex-adjusted models with death as a competing risk, the hazard ratios for hospital readmission within 180 days were 2.29 (95% CI, 1.70-3.09) for frailty and 1.58 (95% CI, 1.15-2.18) for probable dementia.Conclusions and RelevanceIn this nationally representative cohort study of community-living older US residents, the likelihood of hospital readmissions within 180 days after major surgery was increased among older persons who were frail or had probable dementia, highlighting the potential value of these geriatric conditions in identifying those at increased risk.

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Six-month readmissions after bariatric surgery: Results of a nationwide analysis

Cited by 24 publications

References 17 publications

Bariatric surgery prior to transplantation and risk of early hospital re-admission, graft failure, or death following kidney transplantation

Bariatric surgery prior to transplantation and risk of early hospital re-admission, graft failure, or death following kidney transplantation

The Effect of Social Determinants and Socioeconomic Status on Laparoscopic Roux-En-Y Gastric Bypass for Weight Loss: An Analysis of the National Inpatient Sample

National Estimates of Short- and Longer-Term Hospital Readmissions After Major Surgery Among Community-Living Older Adults

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