Risk factors for postoperative mortality in bariatric surgery

Abstract

Introduction. Appropriate patient selection is crucial to the success of bariatric surgery (BaS). The objective of this study was to identify risk factors of increased postoperative mortality in patients undergoing BaS on a national level. Methods. BaS patients ≥18 years old in the United States were identified from the 2001 Nationwide Inpatient Sample (NIS). The effect of gender, age, insurance status, and need for reoperation on postoperative mortality was examined using multivariate logistic regression accounting for the NIS stratified sampling design and using comorbidity adjustments appropriate for index hospitalization data. Results. Analysis of 7,452,727 discharges identified 10,503 bariatric surgical patients meeting inclusion criteria. Estimates were generalizable to a national cohort of 52,098 patients with age 41 ± 10 years (mean ± SE), 84% women, length of stay (LOS) 3.9 ± 0.2 days, and overall mortality of 4 per 1000 BaS patients. Risk factors for postoperative in-hospital mortality are shown (Table). Mean LOS of those who died was 17.6 ± 3.7 days. Conclusion. Based on national data, risk factors for increased postoperative mortality in BaS patients include male gender, age > 39 years, Medicaid insured, and need for reoperation. These data can assist in optimizing BaS patient selection. ∗ % of BaS population Odds ratio for death ∗ 95% Confidence interval ∗ P value ∗ Female 84 (ref) (ref) Male 16 2.1 1.1–4.3 0.04 Age 18–39 46 (ref) (ref) Age 40–49 32 2.6 1.1–6.5 0.04 Age 50–59 19 4.3 1.7–11 0.002 Private Insurance 83 (ref) (ref) Medicaid 4.7 3.9 1.2–13 0.03 No reoperation † 99 (ref) (ref) Reoperation 1 22 5.4–88 0.0001 ∗ Adjusted for factors in table plus race, region and comorbidities; † Reoperation during original admission; ref = referent group