Factors implicated in discharge disposition following elective bariatric surgery.

Abstract

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