Thirty-Day Readmission After Laparoscopic Sleeve Gastrectomy—a Predictable Event?

• Published in: Journal of gastrointestinal surgery 2016-02, Vol.20 (2), p.244-252
• Main Authors: Sethi, Monica, Patel, Karan, Zagzag, Jonathan, Parikh, Manish, Saunders, John, Ude-Welcome, Aku, Somoza, Eduardo, Schwack, Bradley, Kurian, Marina, Fielding, George, Ren-Fielding, Christine
• Format: Article
• Language: English
• Subjects: 2015 SSAT Poster Presentation; Adolescent; Adult; Bariatric Surgery - adverse effects; Emergency medical care; Female; Gastrectomy - adverse effects; Gastroenterology; Gastrointestinal surgery; Hospitals; Humans; Laparoscopy; Laparoscopy - adverse effects; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Obesity - complications; Obesity - surgery; Pain; Patient Readmission; Patients; Retrospective Studies; Risk Factors; Surgery; Young Adult
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-015-2978-x

Background Thirty-day readmission post-bariatric surgery is used as a metric for surgical quality and patient care. We sought to examine factors driving 30-day readmissions after laparoscopic sleeve gastrectomy (LSG). Methods We reviewed 1257 LSG performed between March 2012 and June 2014. Readmitted and nonreadmitted patients were compared in their demographics, medical histories, and index hospitalizations. Multivariable regression was used to identify risk factors for readmission. Results Forty-five (3.6 %) patients required 30-day readmissions. Forty-seven percent were readmitted with malaise (emesis, dehydration, abdominal pain) and 42 % with technical complications (leak, bleed, mesenteric vein thrombosis). Factors independently associated with 30-day readmission include index admission length of stay (LOS) ≥3 days (OR 2.54, CI = [1.19, 5.40]), intraoperative drain placement (OR 3.11, CI = [1.58, 6.13]), postoperative complications (OR 8.21, CI = [2.33, 28.97]), and pain at discharge (OR 8.49, CI = [2.37, 30.44]). Patients requiring 30-day readmissions were 72 times more likely to have additional readmissions by 6 months (OR 72.4, CI = [15.8, 330.5]). Conclusions The 30-day readmission rate after LSG is 3.6 %, with near equal contributions from malaise and technical complications. LOS, postoperative complications, drain placement, and pain score can aid in identifying patients at increased risk for 30-day readmissions. Patients should be educated on postoperative hydration and pain management, so readmissions can be limited to technical complications requiring acute inpatient management.