Bariatric Surgery Center Research Articles

Identifying High-Quality Bariatric Surgery Centers: Hospital Volume or Risk-Adjusted Outcomes?

Identifying High-Quality Bariatric Surgery Centers: Hospital Volume or Risk-Adjusted Outcomes?

Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database

BackgroundThe Bariatric Outcomes Longitudinal Database (BOLD) is a registry of self-reported bariatric surgery patient information from the American Society for Metabolic and Bariatric Surgery Bariatric Surgery Center of Excellence participants. The present study was undertaken to define the baseline characteristics of the patients with data entered into BOLD. MethodsThe data submitted by >800 surgeons and >450 facilities using BOLD before May 20, 2009, were analyzed. ResultsA total of 57,918 research-consented patients with surgical procedure data were included. Of the 57,918 patients, 41,243 were adults aged 26–55 years, with few patients aged ≤18 years (.14%) or ≥66 years (5.67%). Females constituted a significant majority of the study population (45,619 [78.76%]). Of the 57,918 patients, 78.12% registered were described as Caucasian, 10.52% as African-American, 6.02% as Hispanic, .20% as Asian, and .46% as Native American. The most common bariatric surgical procedure was some form of gastric bypass (31,668 [54.68%]), followed by some form of gastric banding (22,947 [39.62%]), sleeve gastrectomy (1,328 [2.29%]), and biliopancreatic diversion (517 [.89%]). The vast majority of index procedures were completed using laparoscopic surgery techniques, except for biliopancreatic diversion, which was primarily done with an open approach. Through May 2009, 78 deaths were reported at any point after the index procedure, for a mortality rate of .13%. The 90-day mortality rate was .11%, and the 30-day mortality rate was .09%. ConclusionThis is the first report of data from BOLD. The data have revealed important characteristics of patients undergoing bariatric surgery across the United States in centers participating in the Bariatric Surgery Center of Excellence program. Future analyses of BOLD data are likely to have a major effect on the specialty of bariatric surgery.

Identifying High-Quality Bariatric Surgery Centers: Hospital Volume or Risk-Adjusted Outcomes?

Payers and professional organizations are expanding accreditation and "centers of excellence" programs in bariatric surgery. Rather than directly measuring outcomes, most programs rely on procedure volume. We sought to determine whether risk-adjusted outcomes or hospital volume were better at predicting future hospital morbidity with bariatric surgery. We identified all patients who underwent gastric bypass in the New York State Inpatient database (n = 32,381 patients, n = 105 hospitals). Morbidity was ascertained using a previously validated combination of diagnostic and procedure codes. We first calculated the risk-adjusted morbidity and volume at each hospital during a 2-year period (2003 to 2004). We then ascertained the proportion of hospital-level variation explained by each measure using hierarchical modeling techniques. Finally, we compared the ability of each measure to predict future performance, as assessed with risk-adjusted morbidity, in the next 2 years (2005 to 2006). Risk-adjusted morbidity explained 83% of future hospital-level variation in morbidity compared with only 21% for hospital volume. When comparing the "best" with the "worst" hospital quartiles, risk-adjusted morbidity predicted a more than fourfold difference in future performance (1.7% versus 7.2%; odds ratio [OR]: 4.5; 95% CI, 3.5 to 5.9). Hospital volume predicted only a twofold difference (2.5% versus 4.5%; OR: 1.9; 95% CI, 1.5 to 2.4) from the best to worst quartile. Risk-adjusted morbidity is much better than hospital volume at predicting future performance with bariatric surgery. Rather than focusing on volume, accreditation and centers of excellence programs should focus more on directly measuring outcomes.

Laparoscopy-assisted ERCP: experience of a high-volume bariatric surgery center (with video)

Laparoscopy-assisted ERCP (LAERCP) allows the diagnosis and treatment of biliopancreatic conditions in patients with Roux-en-Y anatomy (RY). However, experience with this technique is limited. To report on the experience with LAERCP in consecutive patients from a high-volume bariatric surgery center and to evaluate success rates of ERCP with the laparoscopy-assisted approach. Retrospective case series. High-volume bariatric surgery center. Consecutive patients undergoing LAERCP between 2003 and 2009. LAERCP. Immediate/delayed complications, biliary/pancreatic duct cannulation, endoscopic/laparoscopic interventions, postprocedure hospital stay, procedure duration. Ten patients underwent LAERCP: 9 after Roux-en-Y gastric bypass (RYGB) and 1 after antrectomy with RY (9 female, 1 male; 9 white, 1 black). Indications for the procedure were choledocholithiasis (n=4), biliary stricture (n=3), and sphincter of Oddi dysfunction (n=3). Endoscopic access was obtained to the gastric remnant (n=9) or biliopancreatic limb (n=1). Biliary cannulation was successfully achieved in 9 of 10 patients, biliary sphincterotomy was performed in all, pancreatography in 3 of 3, and sphincter of Oddi manometry in 2. In 1 patient, a 3F pancreatic duct stent was placed prophylactically. Mild post-ERCP pancreatitis developed in 2 patients, and 1 patient had a pneumothorax intraoperatively that was treated successfully. The mean duration of the procedure was 89 minutes (range 41-245), and the median postprocedure hospital stay was 2 days (mean 2.59, standard deviation 2.46). Single-center, retrospective design. LAERCP is safe and successful for the diagnosis and therapy of biliopancreatic conditions in patients with RY. It additionally allows the diagnosis and treatment of internal hernias, a known complication of RYGB.

Laparoscopic Sleeve Gastrectomy: An Indian Experience—Surgical Technique and Early Results

Obesity has been observed to be on the rise in the Indian subcontinent. We report our early experience with the laparoscopic sleeve gastrectomy (LSG) for treating morbid obesity in the Indian population along with description of the surgical technique. The data of 75 patients who underwent LSG for the treatment of morbid obesity at the Minimal Access, Metabolic and Bariatric Surgery Centre, Sir Ganga Ram Hospital, Delhi, from November 2006 to February 2009, were retrospectively reviewed from prospective database. The gastric sleeve is created laparoscopically using sequential firings of a linear stapling device applied alongside a 36-Fr calibrating bougie. The data collected included age, gender, initial body mass index (BMI) and excess weight, the co-morbidity status, and preoperative investigations. Perioperative parameters and follow-up details [weight, BMI, excess weight loss (%EWL), resolution of co-morbidities, and postoperative investigations] were noted. All procedures were completed laparoscopically. There was no major procedure-related morbidity. Hemorrhage requiring blood transfusion was observed in four patients. One patient died at 2weeks postoperatively due to pulmonary embolism. There was a steady rise in %EWL from 31.2% at 3months to 52.3% at 6months, 59.13% at 1year, and 65% at 2years. Type II diabetes was resolved in 81.2%, hypertension in 93.75%, and dyslipidemia in 85% at 1year. Although long-term results are necessary to determine the benefits of the procedure, early results indicate that LSG may be a safe and feasible option for treating the morbidly obese patients.

Endoscopic management of eroded prosthesis in vertical banded gastroplasty patients

One of the major complications of applying a prosthetic device to facilitate gastric partitioning has been intraluminal erosion of the prosthesis. Removing an eroded gastric band is fraught with difficulty secondary to the extensive inflammatory response around the proximal stomach and left lobe of the liver. As a result, bariatric clinicians have attempted to apply endoscopic technology to facilitate removal of eroded gastric prostheses. Our study reports on our experience of applying endoscopic scissor transection to remove eroded gastric prostheses in a large tertiary-care medical center. A retrospective chart review was conducted to identify all adult (>18 years old) patients managed endoscopically for removal of eroded prosthesis post bariatric surgery at the Baylor College of Medicine Comprehensive Bariatric Surgery Center and the University of Texas-Houston Bariatric Surgery Program. Nine patients, mean body mass index (BMI) 39.5 +/- 7.3 kg/m(2), were managed endoscopically to remove eroded gastric prosthesis post vertical banded gastroplasty. All patients (9/9) reported symptoms consistent with a proximal gastric outlet obstruction (dysphagia, nausea, vomiting). Inadequate weight loss was reported by 67% (6/9) of patients. The mean time for endoscopic band removal was 28.0 +/- 8.8 min. All eroded bands were evident at the end of the gastric pouch and were visualized with either a normal or retroflexed endoscopic view. All nine patients were discharged the same day of their procedure. Mean follow-up of the patients was 9.7 weeks (1-30 weeks). Three patients underwent revisional bariatric surgery following the band removal. Our study demonstrates that endoscopic scissor transaction is a safe and effective modality in removing eroded gastric prostheses after vertical banded gastroplasty and avoids the pitfalls associated with removing the eroded bands surgically. It also allows the patient and surgeon to make an insightful decision regarding a revisional bariatric surgical procedure, without being contingent on addressing the eroded gastric band.

PL-108: Baseline data from ASMBS-designated bariatric surgery centers of excellence (BSCOE) using the bariatric outcomes longitudinal database (BOLD)

PL-108: Baseline data from ASMBS-designated bariatric surgery centers of excellence (BSCOE) using the bariatric outcomes longitudinal database (BOLD)

Bariatric Surgery Outcomes at Designated Centers of Excellence vs Nondesignated Programs

To compare outcomes of patients undergoing bariatric procedures in hospitals designated as centers of excellence compared with nondesignated hospitals. The 2005 National Inpatient Survey was used to compare outcomes at designated vs nondesignated hospitals. In addition to conventional null-hypothesis statistical testing to assess differences, effect sizes were calculated to estimate the clinical significance for observed differences. Centers of excellence performed substantially more operations than nondesignated centers. Despite this, outcomes were equivalent at centers of excellence and hospitals without this designation. Volume-outcome modeling attempting to identify the optimal number for a minimum volume threshold for bariatric operations revealed that annual procedure volume has a weak effect on outcomes. Similarly, many variables that were statistically significantly different between centers and noncenters proved to be clinically unimportant by effect size analysis. Risk adjustment was effectively achieved by using the Agency for Healthcare Research and Quality-supplied variables all-payer severity-adjusted diagnostic related group expected charges and deaths. Designation as a bariatric surgery center of excellence does not ensure better outcomes. Neither does high annual procedure volume. Extra expenses associated with center of excellence designation may not be warranted.

Demographics and outcomes at American Society for Metabolic and Bariatric Surgery Centers of Excellence

Surgery is currently an effective long-term therapy for morbid obesity and its complications. A variety of surgical procedures can now offer durable and safe weight control as well as previously unrealized full remission of costly comorbidities. This is a preliminary investigation of patient characteristics and outcomes at Bariatric Surgery Centers of Excellence) (BSCOE) hospitals. Data were analyzed from 235 American Society for Metabolic and Bariatric Surgery (ASMBS) BSCOE hospitals receiving Full Approval status from August 2005 to May 2007. Metrics for the 66,339 bariatric surgeries performed at these hospitals included type, volume and distribution of various bariatric surgical procedures performed at each hospital, patient demographics, payer information, and adverse outcomes. Data from these analyses demonstrate significant differences in terms of surgical procedure selection (laparoscopic gastric bypass 61%), patient demographics (females 83%, White 60%, mean age 43 years) and type of payer (private insurance 78%), and adverse outcomes (readmission 5%, re-operation 2%, mortality 0.36%). The collective performance of ASMBS BSCOE hospitals in bariatric outcomes of readmissions, re-operations, and mortality are equivalent to, or more favorable, than currently reported outcomes. However, risk assessment and risk adjustment of the patients and each of the bariatric procedures will be necessary to appropriately evaluate these rates.

Preparation for a Bariatric Center of Excellence Site Survey

Morbid obesity continues to be a growing problem in the United States. Between 1997 and 2003, the number of U.S. hospitals offering bariatric surgery has nearly tripled. Confronted with increasing demands for bariatric surgery, competency of nursing staff caring for the bariatric surgery patient has emerged as a key area of focus. This article highlights the innovative creation and implementation of a bariatric surgery competency program that would meet the competency standards for a Bariatric Surgery Center of Excellence.

Maine Medical Center Bariatric Surgery Center

Maine Medical Center Bariatric Surgery Center

The Challenge of CT and MRI Imaging of Obese Individuals Who Present to the Emergency Department: A National Survey

The objective of this study was to estimate the availability of large weight capacity computed tomography (CT) and magnetic resonance imaging (MRI) equipment in US hospitals with emergency departments (EDs) and to evaluate animal facilities as alternate sources of imaging. We conducted a telephone survey of radiology technicians from a random sample of all the US hospitals with EDs (n = 262) and all 136 primary hospitals of academic EDs, 145 zoos, and 28 veterinary schools. We measured the prevalence of large weight capacity (>450 lb) CT and MRI, stratified by hospital characteristics. Response rates were 94-100% across samples. Nationally, 10% (95% confidence interval, 7-15) of hospitals with EDs had large weight capacity CT and 8% (95% confidence interval, 5-13) had large weight capacity MRI. In academic hospitals, access to large capacity equipment was better for CT (28%), but similar for MRI (10%) (P < 0.001 and 0.51, respectively). Few rural (5%) and critical-access hospitals (3%) had large capacity CT. In addition, 34% of trauma centers, 23% of stroke centers, and 21% of bariatric surgery centers of excellence had large capacity CT. Only two zoos (1%) had CT scanners; both would not image human patients. Among veterinary schools, 16 (57%) had large weight capacity CT equipment, but only 4 (14%) would consider imaging human patients. Further, 23 (82%) veterinary schools reported policies that specifically prohibited imaging humans. For patients who weigh >450 lb, access to emergent CT and MRI is limited, even at academic and bariatric surgery centers. Animal facilities are not a viable alternative for diagnostic imaging of human patients.

Bariatric surgery for treatment of morbid obesity in an adolescent with Marfan syndrome

A 16 year old Caucasian female with genetically confirmed Marfan syndrome and extreme obesity (weight: 205 kg, height: 176 cm, BMI: 66 kg/m 2) was referred to Cincinnati Children's Hospital Comprehensive Weight Management Center for bariatric surgery. Her comorbidities attributed to obesity included: obstructive sleep apnea, hyperinsulinemia, hypertension, left ventricular hypertrophy, gastroesophageal reflux, urinary stress incontinence, and irregular menses. Her family history was concerning for sudden death from aortic dissections as early as the 2nd decade of life for other individuals with Marfan syndrome and concomitant severe obesity. Cardiac imaging at time of referral was limited secondary to poor acoustic windows for echocardiography and body habitus which restricted the use of traditional scanners. Initial challenges included estimating her surgical risk due to her connective tissue disease and the unknown status of her aorta. Additional cardiac Magnetic Resonance (MR) imaging demonstrated no aortic dilation. She underwent uneventful laparoscopic Roux-en-Y gastric bypass surgery and recovery. Six months later her weight had decreased to 162 kg (BMI: 52.0 kg/m 2, weight loss: 43 kg). Hyperinsulinemia improved (fasting insulin: 38.9 → 19.7 uU/ml), and left ventricular mass improved (55 → 39 g/m 2.7). This is the first case highlighting the safety and potential impact of surgical weight loss in the management of an adolescent with Marfan syndrome. Lifelong followup is recommended due to long term risks of Marfan syndrome, and independent nutritional risks of gastric bypass surgery.

One-year Readmission Rates at a High Volume Bariatric Surgery Center: Laparoscopic Adjustable Gastric Banding, Laparoscopic Gastric Bypass, and Vertical Banded Gastroplasty-Roux-en-Y Gastric Bypass

An increasing importance has been placed on a bariatric program's readmission rates. Despite the importance of such data, there have been few studies that document 1-year readmission rates. There have been even fewer studies that delineate the causes of readmission. The objective of this study is to delineate the rates and causes of readmissions within 1 year of bariatric operations performed in a high-volume center. Records for all patients undergoing bariatric operations during a 31-month period were harvested from the hospital electronic medical database. Readmissions for these patients were then identified within the hospital database for the year following the index operation. The electronic medical records of all readmitted patients were reviewed. The overall 1-year readmission rate for 1,939 consecutive bariatric operations was 18.8%. The laparoscopic adjustable gastric band (LAGB) had the lowest readmission rate of 12.69%. Next was the vertical banded gastroplasty-Roux-en-Y gastric bypass (VBG-RYGB) with a rate of 15.4%. The laparoscopic Roux-en-Y gastric bypass (LRYGB) had the highest readmission rate of 24.2%. Leading causes of readmission were abdominal pain with normal radiographic studies and elective operations. Independent factors predicting readmission were found to be LOS > 3 days (odds ratio 1.69 p = 0.004) and having a LRYGB (odds ratio of 1.49 p = 0.003). The previously reported reoperation rate for bowel obstruction of 9.7% had decreased to 3.7% due to changes in operative technique. Rates of readmissions for patients undergoing bariatric surgery center at our high-volume center decreased over time and are comparable to other major abdominal operations.

PL-38: Low surgical volumes in hospitals that meet surgical review corporation (SRC) bariatric surgery center of excellence (BSCOE) minimum standards do not demonstrate an adverse impact on surgical outcomes

extremities perioperatively and early ambulation reduce venous thromboembolism (VTE) postoperatively. Anti-coagulation medication is recommended by ASMBS to reduce VTE risk. This study examines 30 day post-op VTE or death among bariatric surgery patients who had sequential compression alone (SEQUEN) or with anticoagulation (ANTICOAG). Methods: LABS participants from 10 centers in the US who underwent their first bariatric surgery between 3/2005 and 10/2007 comprise the study group. We examined 30-day incidence of VTE, defined as DVT or PE, and mortality. Results: Of 3,539 patients, 370 (10%) received sequential compression alone, while the others also received anticoagulation therapy. The two groups were similar in age, race, ethnicity, and BMI. There was a significantly higher percentage of males (30% vs. 20%, p 0.0001) and smokers (7% vs. 3%, p 0.003) in the SEQUEN group. The prevalence of hypertension, diabetes, congestive heart failure, history of VTE , vena cava filter, ischemic heart disease, and pulmonary hypertension at baseline, were not significantly different. The SEQUEN group had longer operative times (207 vs. 169 min, p .0001). The two groups were similar in % of re-hospitalization and re-operation. Open surgery was associated with 1.8% of VTE, and laparoscopic surgery with 0.4%. After adjusting for sex, current smoking, length of operation, and history of VTE, there was not a significant difference between groups in the combined incidence of DVT/PE/mortality (1.0% in ANTICOAG versus 0.4% in SEQUEN, p 0.25). Conclusion: The overall incidence of VTE or death was small (1%). The addition of anticoagulation to the use of sequential compression devices may not lower the rate of VTE following bariatric surgery. Further study of this topic is warranted (sample size). PII: S1550-7289(08)00406-1

Current nutrition management of patients undergoing bariatric surgery

CURRENT NUTRITION MANAGEMENT OF PATIENTS UNDERGOING BARIATRIC SURGERY Nazy Zarshenas, Department of Nutrition & Dietetics, St George Upper GI Surgical Unit, Sydney, Australia. Obesity is emerging as the most challenging chronic health problem facing our society, surpassing smokingrelated illnesses, with a prevalence rate in Australian adults of 20%. Medical treatments have poor results with a 1-2% long term success rate. Weight loss surgery is the most effective treatment for morbid obesity (1), as it resolves the consequences of obesity (2,3) as well as decreasing the mortality rate in this population (3). There are no evidence-based guidelines for nutrition management of patients pre and post bariatric surgery (4). An interest group was developed for the dietitians working in this area and a survey was subsequently undertaken to determine the current nutrition management in this growing field and identify the shortfalls. The survey results indicate that most bariatric surgery centers use a weight loss program pre operatively. The duration and intensity of this depends on the severity of the patient’s obesity as well as their tolerance for the intervention. Post operatively nutrition counselling is provided at the hospital level and the diet is progressed according to patients’ tolerance and the clinicians’ experience. Recommendations for energy, protein and multivitamin supplementations are inconsistent and not evidence based. Micronutrients such as Calcium, Vitamin D, and Iron are not routinely supplemented. Long-term food intolerances were identified as these may contribute to nutritional inadequacy in this population. Ongoing counselling and education is essential to change eating habits, reinforce a healthy balanced diet and ensure compliancy with micronutrient supplementation. Further research is warranted in this growing field.

Bariatric Surgery: Low Mortality at a High-Volume Center

The American Society of Bariatric Surgery has initiated a Bariatric Surgery Center of Excellence Program and the American College of Surgeons has followed with their Bariatric Surgery Center Network Accreditation Program. These programs postulate that concentration of weight loss operations in high-volume centers will decrease surgical mortality and improve outcomes. The purpose of this study was to calculate the in-hospital mortality for bariatric operations accomplished at the highest volume bariatric surgery center in the state of New Jersey. After receiving Institutional Revew Board approval, the revised surgical schedule was used to identify all patients undergoing weight loss surgery (WLS) at Hackensack University Medical Center from 1998 through June, 2006. Data for these patients were then harvested from the hospital's electronic medical record. Step-wise and univariate logistic regression analysis tested the impact of various factors on hospital length of stay and in-hospital mortality. Between 1998 and June, 2006, 5,365 patients underwent WLS surgery: 2,099 open vertical banded gastroplasty-Roux en Y gastric bypass (VBG-RYGB); 2,177 laparoscopic Roux en Y gastric bypass (LRYGB); and 1,089 laparoscopic adjustable gastric banding (LAGB). 75.5% of patients were women. Median age was 41 years old (13-79), median weight 128 kg (81.2-290.3), and median body mass index 46.1 kg/m2 (35.0-92.6). Median total operating room time for VBG-RYGB was 115 min (33-328); LRYGB 155 min (53-493), and LAGB 92 min (33-274). Median length of stay for VBG-RYGB was 3 days (1-39 days), LRYGB 2 days (1-46 days), and LAGB 1 day (1-20). Seven patients died in hospital after the 5,365 WLS operations (0.13%): four after VBG-RYGB (0.19%); three after LRYGB (0.14%); and none after LAGB (0%). The characteristics of the patients who died did not significantly differ from the group as a whole. Surgeons at Hackensack University Medical Center, a high volume, accredited 1A American College of Surgeons Bariatric Surgery Center, achieved a 0.13% mortality among 5,365 patients undergoing weight loss operations between 1998 and June, 2006. This study supports the concept that high-volume centers perform bariatric operations with low mortalities.

Short-term outcomes for super-super obese (BMI ≥60 kg/m2) patients undergoing weight loss surgery at a high-volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and open tubular gastric bypass

We previously reported significantly longer operating room times and a trend toward increased complications and mortality in the super-super obese (body mass index [BMI] > or =60 kg/m(2)) early in our experience with laparoscopic Roux-en-Y gastric bypass. The goal of this study was to re-examine the short-term outcomes for super-super obese patients undergoing weight loss surgery at our high-volume bariatric surgery center well beyond our learning curve. The records for all patients who had undergone weight loss surgery at Hackensack University Medical Center from 2002 to June 2006 were harvested from the hospital's electronic medical database. This population was analyzed as 2 groups (those with a BMI <60 kg/m(2) and those with a BMI > or =60 kg/m(2)), as well as by type of operation. Step-wise and univariate logistic regression analyses assessed the effect of BMI on the outcome variables, including mortality, length of surgery, length of hospital stay, and disposition at discharge. A total of 3692 patients were studied. Of these patients, 3401 had a BMI <60 kg/m(2) and 291 had a BMI > or =60 kg/m(2). Of the 291 super-super obese patients, 130 underwent vertical banded gastroplasty-Roux-en-Y gastric bypass, 116 laparoscopic Roux-en-Y gastric bypass, and 45 laparoscopic adjustable gastric banding. The proportion of male patients, black patients, and patients with sleep apnea was increased in the BMI > or =60 kg/m(2) group. The number of co-morbid diseases per patient correlated with age but not BMI. The BMI > or =60 kg/m(2) group required a significantly longer total operating room time (136 versus 120 min). Hospital length of stay was significantly longer only in the laparoscopic Roux-en-Y gastric bypass patients (3 d for the BMI > or =60 kg/m(2) group versus 2 d for the BMI <60 kg/m(2) group). A significantly greater percentage of patients in the super-super obese group were discharged to chronic care facilities. The overall in-hospital mortality rate was 0.15% (5 of 3692) but did not significantly differ between the 2 groups: BMI <60 kg/m(2), rate of 0.12% (4 of 3401 patients), and BMI > or =60 kg/m(2), rate of 0.34% (1 of 291 patients). The type of operation did not significantly affect the disposition at discharge or in-hospital mortality. Super-super obese patients required longer total operating room times, a longer hospital length of stay, and were more likely to be discharged to chronic care facilities than were patients with a BMI <60 kg/m(2); however, the in-hospital mortality was similar for both groups.

30-Day readmission rates at a high volume bariatric surgery center: Laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass

Recent studies suggest that weight loss operations may actually increase the costs to society due to increased hospital readmission rates. The purpose of this study was to determine the 30-day readmission rates following bariatric operations at a high volume bariatric surgery program. Records for all patients undergoing bariatric operations during a 3-year period were harvested from the hospital electronic medical database. All hospital readmissions within 30 days of surgery were reviewed to determine the cause, demographics, and patient characteristics. Logistic regression analysis assessed the impact of various factors on the risk of readmission. 2,823 consecutive patients were identified using the corrected operative log. Of these patients, 165 (5.8%) patients required 184 (6.5%) readmissions within 30 days of their index bariatric operation. Laparoscopic adjustable gastric banding (LAGB) had the lowest patient readmission rate of 3.1%; vertical banded gastroplasty-Roux-en-Y gastric bypass (VBG-RYGBP) 6.8% and Laparoscopic Roux-en-Y gastric bypass (LRYGBP) 7.3%. Technical considerations were the most common cause for readmission (41% of readmissions). White race and undergoing LAGB decreased the odds for readmission, while total operating-room time >120 minutes, initial hospital stay of >3 days and deep venous thrombosis increased the odds for readmission. This study found an overall 30-day readmission rate of 6.5% following bariatric operations at a high volume bariatric surgery program. This study supports the concept of bariatric surgery Centers of Excellence and accreditation of Bariatric Surgery Programs based on hospital volume of bariatric operations.

30-Day readmission rates at a high volume bariatric surgery center: Laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass

30-Day readmission rates at a high volume bariatric surgery center: Laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass