Predictors of readmission after laparoscopic gastric bypass and sleeve gastrectomy: a comparative analysis of ACS-NSQIP database

Background Readmission rate is an indicator of quality in surgical practice. We aimed to determine the predictors of unplanned early readmissions following stapling bariatric surgeries. Methods From the American College of Surgeons National Surgical Quality Improvement Program database, we identified morbidly obese patients, who underwent either laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in 2012 and 2013. Demographic, comorbidities, operative and postoperative parameters of the readmitted (within 30 days) and non-readmitted patients were evaluated using a multivariate logistic regression analysis. Results A total of 35,655 patients (17,101 LSG and 18,554 LRYGB) were analyzed. Of those, 1758 patients (4.9 %) were readmitted within 30 days of surgery. Multivariate analysis showed the following significant predictors for readmission: Non-Hispanic black ethnicity (OR: 1.56, 95 % CI: 1.34-1.81), Hispanic ethnicity (OR: 1.29, 95 % CI: 1.05-1.58), totally or partially dependent functional status (OR: 1.94, 95 % CI: 1.06-3.55), higher preoperative creatinine (OR: 1.13, 95 % CI: 1.04-1.22), lower serum albumin (OR: 0.78, 95 % CI: 0.68-0.90), diabetes mellitus on insulin (OR: 1.28, 95 % CI: 1.09-1.51), steroid or immunosuppressant use for a chronic condition (OR: 1.61, 95 % CI: 1.11-2.33), history of cardiac disease with intervention (OR: 2.05, 95 % CI: 1.10-3.83), bleeding disorders (OR: 1.71, 95 % CI: 1.15-2.54), LRYGB versus LSG (OR: 1.63, 95 % CI: 1.44-1.85), longer operative time (OR: 1.13, 95 % CI: 1.07-1.20), concurrent splenectomy (OR: 4.10, 95 % CI: 1.05-16.01), and occurrence of any postoperative complication during index admission (OR: 2.61, 95 % CI: 1.99-3.42). Conclusions Ethnicity, baseline functional status, comorbidities, type and duration of surgical procedure, and postoperative complications occurred in the index admission can predict risk of early readmission following LRYGB and LSG.