Trends in risk factors for readmission after bariatric surgery 2015-2018

Abstract

Background: Readmission after bariatric surgery is multifactorial. Understanding the trends in risk factors for readmission provides opportunity to optimize patients prior to surgery identify disparities in care, and improve outcomes.

Objectives: This study compares trends in bariatric surgery as they relate to risk factors for all-cause readmission.

Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) participating facilities.

Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was used to analyze 760,076 bariatric cases from 854 centers. Demographics and 30-day unadjusted outcomes were compared between laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (LSG), and Roux-en-Y gastric bypass (RYGB) performed between 2015 and 2018. A multiple logistic regression model determined predictors of readmission.

Results: A total of 574,453 bariatric cases met criteria, and all-cause readmission rates decreased from 4.2% in 2015 to 3.5% in 2018 (P < .0001). The percentage of non-Hispanic Black adults who underwent bariatric surgery increased from 16.7% of the total cohort in 2015 to 18.7% in 2018 (P < .0001). The percentage of Hispanic adults increased from 12.1% in 2015 to 13.8% in 2018 (P < .0001). The most common procedure performed was the LSG (71.5%), followed by RYGB (26.9%) and 1.6% LAGB (1.6%) (P < .0001). Men were protected from readmission compared with women (odds ratio [OR]: .87; 95% confidence interval [CI]: .84-.90). Non-Hispanic Black (OR: 1.52; 95% CI: 1.47-1.58)] and Hispanic adults (OR: 1.14; 95% CI: 1.09-1.19) were more likely to be readmitted compared with non-Hispanic White adults. LSG (OR: 1.27; 95% CI: 1.10-1.48) and RYGB (OR: 2.24; 95% CI: 1.93-2.60) were predictive of readmission compared with LAGB.

Conclusion: Readmission rates decreased over 4 years. Women, along with non-Hispanic Black and Hispanic adults, were more likely to be readmitted. Future research should focus on gender and racial disparities that impact readmission.

Keywords: Complications; Gender; MBSAQIP; Readmission; Sleeve gastrectomy; Trends.