S. Y. Chen2, M. Stem1, A. O. Lidor1 1Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 2Johns Hopkins University School Of Medicine,Baltimore, MD, USA
Introduction:
Although outcomes during hospitalization for patients undergoing bariatric surgery are well known, little is reported about post-discharge complications (PDC) and their implications in this population. We sought to identify the rate of PDC, associated risk factors, and their influence on the early outcomes after bariatric surgery.
Methods:
This was a retrospective study using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data from 2005 through 2012. Patients ≥ 18 years of age who underwent a bariatric surgical procedure (laparoscopic adjustable band, laparoscopic gastric bypass [GBP], open GBP, and sleeve gastrectomy) with a primary diagnosis of morbid/severe obesity and BMI ≥ 35 were included. PDC was the primary outcome, defined as an event for which time interval (days) between bariatric surgery and complication was greater than the interval from the surgery to discharge. Secondary outcomes included readmission and reoperation (only available for 2011-2012). We examined the association between PDC and various factors (including length of stay [LOS] and operative time) using multivariable logistic regression. A subset analysis was performed by procedure type.
Results:
A total of 94,415 patients were identified for whom the overall PDC rate within 30-days post-surgery was 3.1%. The rate of PDC decreased significantly from 2005-6 (4.6%) to 2012 (2.7%) (p<0.001). In comparison to patients who experienced no complication or only a pre-discharge complication (PrDC), PDC patients were older, had higher ASA class, greater BMI, and more comorbidities. On average, PDC occurred 9 days post-operatively, with wound infection, urinary tract infection, shock/sepsis, and organ space surgical site infection being the most common. Open GBP patients had the highest PDC rate (8.5%). Only 3.5% of patients experienced both PrDC and PDC. 46.7% of PDC patients were readmitted, and 41.9% required a reoperation. The factors most strongly associated with an increased odds of PDC were BMI ≥ 50, steroid use, procedure type, PrDC, and prolonged LOS and operative time (Table).
Conclusion:
Although the rate of PDC after bariatric surgery is low, it accounts for a significant number of readmissions. Adoption of best practices for prevention of surgical site infection and catheter-associated urinary tract infection, as well as standardized protocols for outpatient monitoring of patients identified to be at high risk of experiencing PDC, should be considered.
