Dr. Andrea Lazzati

Readmission rate in bariatric surgery: a nationwide study on 320.000 patients

Bariatric surgery is the most effective and durable weight loss method and is associated with favorable metabolic outcomes, including improvement of diabetes, hypertension, dyslipidemia, liver steatosis, sleep apnea, and survival rate among morbidly obese individuals. The STAMPEDE trial showed that bariatric procedures are effective and seem to be retained at 1 and 3 years. In 2015, the WHO estimated that there were more than 700 millions of morbid obese adults. Therefore, bariatric procedures are among the most frequently performed in USA en Europe. There are different techniques, but the Roux-en-Y Gastric Bypass (RYGBP) and the Sleeve Gastrectomy (SG) are the most commonly performed. Bariatric surgery has been proven to be also a safe operation. However, one area of quality improvement and cost containment in all surgical specialities is the readmission rate. It has been reported that unplanned hospital 30-day readmissions were estimated to cost Medicare more than $17 billion in 2004 in USA. In bariatric surgery, readmissions are usually preventable, as they are often symptom-related, being abdominal pain, dehydration and nausea/vomiting the most common causes. The reported readmission rates for laparoscopic RYGBP and SG are 1.1-9.0% and 0.7-5.4%, respectively. Some of the risk factors that have independently been associated with postoperative adverse events are comorbidities, treatment with steroids and diabetes, but also any postoperative complication during index admission and even LRYGBP when compared to LSG. Given the increased popularity of the LSG and the different patterns of readmission between both techniques, more investigation is justified. In this talk, Dr. Lazzati analyzes a significant cohort of bariatric patients, aiming to increase the evidence about readmission rates in this population. He also focuses on the differences in the risk factors for readmission compared to the literature. Better understanding of these risk factors will allow hospitals to develop individualized programs to decrease the 30-day readmission rates.