Clinical features and risk factors analysis of 30-day readmission after bariatric and metabolic surgery

Abstract

Objective To explore the incidence, clinical features, causes, treatment method and risk factors of 30-day readmission after bariatric and metabolic surgery. Methods The retrospective case-control study was conducted. The clinical data of 631 obese patients who underwent bariatric and metabolic surgery in the First Affiliated Hospital of Nanjing Medical University from May 2010 to May 2016 were collected. All the 631 patients underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). Patients were followed up by outpatient examination and telephone interview for 1 month to detect readmission of patients up to June 2016. Observation indicators: (1) 30-day readmission situations after bariatric and metabolic surgery: cases with readmission, readmission time, clinical features, causes and treatment of readmission; (2) risk factors analysis affecting 30-day readmission after bariatric and metabolic surgery. Measurement data with skewed distribution were described as M (range). The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model. Results (1) Thirty-day readmission situations after bariatric and metabolic surgery: among 631 patients receiving postoperative 1-months follow-up, 21 had 30-day readmission, with an incidence of 3.33%(21/631), including 13 males and 8 females; 10 received LSG and 11 received LRYGB. The median readmission time of 21 patients was 12 days (range, 4-30 days). Of 21 patients, nausea, vomiting and dehydration of the main manifestations were detected in 11 patients, gastrointestinal bleeding in 6 patients, high fever in 2 patients, bowel obstruction in 1 patient and abdominal pain in 1 patient. The causes of the readmission of 21 patients: 8 had improper food intake including 5 with premature solid food intake, 1 with premature semi-fluid food intake, 1 with irritating food intake and 1 with swallowing whole tablets; 3 had postoperative over-anxiety; 1 had Petersen hiatal hernia; 1 had anastomotic ulcer; 1 had anastomotic edema; 1 had abdominal abscess. Of 6 patients with uncertain causes, 4 had gastrointestinal bleeding and didn't receive endoscopy; 1 had postoperative unexplained abdominal pain and underwent laboratory and imaging examinations and gastroscopy, showing no trouble finding; 1 had high fever, and no abnormality was detected by imaging examination. Of 21 patients, 19 underwent conservative treatment (rehydration and acid suppression) and then discharged from hospital after improvement, without readmission; 1 with abdominal abscess was cured after emergency debridement and drainage; 1 with Petersen hiatal hernia was cured by emergency surgery. The median duration of hospital stay in 21 patients with readmission was 7 days (range, 3-40 days). (2) Risk factors analysis affecting 30-day readmission after bariatric and metabolic surgery: the results of univariate analysis showed that gender, preoperative adephagia habit and duration of postoperative hospital stay were related factors affecting 30-day readmission after bariatric and metabolic surgery (χ2=5.330, 6.498, 4.574, P<0.05). The results of multivariate analysis showed that male and preoperative adephagia habit were independent risk factors affecting 30-day readmission after bariatric and metabolic surgery (OR=2.489, 2.912, 95% confidence interval: 1.006-6.161, 1.196-7.088, P<0.05). Conclusions Nausea, vomiting and dehydration are common manifestations of patients with 30-day readmission after bariatric and metabolic surgery, and it might be associated with improper food intake. Male and preoperative adephagia habit are independent risk factors affecting 30-day readmission after bariatric and metabolic surgery. Key words: Obesity; Bariatric surgery; Metabolic surgery; Complications; Readmission