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Correlates of Bariatric Surgery Hospital Readmissions in a High Volume Academic Medical Center
ASMBS E-Poster Abstracts / Surgery for Obesity and Related Diseases 13 (2017) S66–S226
were no significant differences between the two cohorts in weight loss, risk factor improvement, and comorbidity (diabetes, hypertension, and hyperlipidemia) resolution at 3, 6, and 12 months postoperatively (all p40.05). Conclusion: Surgical complications following bariatric surgery do not seem to reduce the success of surgery.
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were poor oral tolerance. Future studies should be conducted to analyze reasons for readmissions so that interventions aimed at reducing readmissions can be implemented.
A5267
CORRELATES OF BARIATRIC SURGERY HOSPITAL READMISSIONS IN A HIGH VOLUME ACADEMIC MEDICAL CENTER Pablo Quadri; Mario Masrur; David Sigmon; Antonio Gangemi; Lisa Sanchez-Johnsen; Chandra Hassan; UIC, Chicago IL
THE EFFECTS OF CIRCULAR STAPLER HEIGHT ON ANASTOMOTIC COMPLICATIONS IN LAPAROSCOPIC ROUX EN Y GASTRIC BYPASS Kieran Purich1; Michael Horkoff2; Noah Switzer3; Shalvin Prasad2; Neal Church2; Xinzhe Shi3; Philip Mitchell2; Estifanos Debru2; Shahzeer Karmali3; Richdeep Gill2; 1University of Alberta, Sherwood Park Alberta; 2University of Calgary, Calgary AB; 3University of Alberta, Edmonton AB
Introduction: Hospital readmissions after bariatric surgery vary according to the surgical procedure but range from 0.5% to 11%. The primary aim of this study is to analyze the correlates of hospital readmissions, including the rate, reasons for hospital readmission and length of hospitalization for readmissions postbariatric surgery [sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB)] in our high volume academic medical center. The secondary aim is to analyze possible predisposing factors related to readmissions. Material and Methods: This is a retrospective study with 378 consecutive patients who underwent a minimally invasive SG or RYGB at the University of Illinois Hospital and Health Sciences System between June 2015 and September 2016. The following data was obtained: demographic characteristics, reason for readmissions, treatment received and length of hospitalization of the readmission. Additional factors related to readmissions will also be examined. Results: A total of 378 patients, 86.5% (n¼327) women and 13.5% (n¼51) men were included in the study. The mean age was 41.4 (SD¼11.4) years old and the mean body mass index at the time of the surgery was 49.3 (SD¼10). Surgeries were distributed and follows: 70.9% SG (265 laparoscopic and 3 robotic) and 29.1% RYGB (8 laparoscopic and 102 robotic). Conversion rate to open was 0.3% (n¼1). The mean operative time and length of hospitalization (LH) for SG and RYGB were 92.5 (SD¼31.4) and 159.0 (SD¼58.7) minutes, and 1.5 (SD¼0.7) and 1.7 (SD¼1.0) days respectively. The reoperation rate was 1.6% (n¼6). The 30-day readmission rates was 4.8% (n¼18). The causes of 30-day readmissions were related to: poor oral tolerance (n¼13, 72.5%), thrombotic thrombocytopenic purpura (n¼1, 5.5%), stroke (n¼1, 5.5%), deep venous thrombosis (n¼1, 5.5%), pulmonary embolism (n¼1, 5.5%) and gastroesophageal reflux (n¼1, 5.5%). The LH for 30-day readmissions was 3.2 (SD¼3.0) days. Of the patients who were readmitted, 55.6% (n¼10) were readmitted within the first week after discharge and the remaining 44.4% (n¼8) were readmitted after 1 week discharge. Additional analyses will be conducted to examine possible predisposing factors to readmissions. Conclusions: Hospital 30-day readmission rates in specialized high volume academic medical centers are an important area of concern and studies should be conducted to analyze reasons for readmissions so that interventions aimed at reducing readmissions can be implemented. The main causes of 30-day readmissions
Background: The laparoscopic Roux en Y gastric bypass (LRYGB) is accepted as the gold standard bariatric operation due to its efficacy and safety profile. Although a safe operation, the Roux en Y does have some morbid complications including: bleeding, stricturing requiring dilation and anastomotic leaks most commonly at the gastrojejunostomy (GJ) staple line. The circular stapler technique is a common method used to create the GJ anastomosis. The height of staples used vary by site and surgeon’s preference. Appropriate sized staples must be used for different tissues to provide appropriate tissue apposition while not inducing tissue ischemia and destruction. Recent studies have suggested that shorter circular stapler heights (3.5mm versus 4.8mm) are associated with fewer postoperative complications in the LRYGB including: lower stricture rates as well as a trend towards a lower incidence of postoperative anastomotic bleeds. This is thought to be related to improved tissue compression associated with the shorter staple height. These previous studies have acknowledged heterogeneity within their data, and slight variations exist within their surgical technique, stapler technology and timelines. These variables have potential to confound previous results. Methods: We completed a retrospective cohort study from the years 2015-2017 within the two primary sites (Edmonton and Calgary) of the Alberta Provincial Bariatric Program (APBP). These two sites preform a standardized LRYGB operation, which varies solely in circular stapler height. Only primary LRYGBs were considered. Results: We identified 214 patients who had underwent LRYGB, 143 in the 3.5mm circular stapler cohort, and 71 in the 4.8mm cohort. The two groups were similar in regards to age (46.3 years versus 44.3 years) and mean preoperative body mass index (46.0 versus 45.1). The rate of anastomotic stricturing requiring balloon dilation was lower in the 3.5mm stapler group in comparison to the 4.8mm stapler group, 3.5% versus 14.1% respectively (p¼0.008). In addition, the post-operative bleed rates requiring transfusion was significantly lower in the 3.5mm group, 6.3% versus 15.5% (p¼0.044). There was no difference in anastomotic leak rates and overall mortality between the two groups. Conclusions: Our data, within a homogenous and standardized obesity provincial network, supports the finding that there is a higher rate of anastomotic stricture and post operative bleeds with the use of a 4.8mm circular stapler in comparison to a 3.5mm circular stapler when forming a gastrojejunostomy in a laparoscopic Roux en Y gastric bypass.
A5266
were no significant differences between the two cohorts in weight loss, risk factor improvement, and comorbidity (diabetes, hypertension, and hyperlipidemia) resolution at 3, 6, and 12 months postoperatively (all p40.05). Conclusion: Surgical complications following bariatric surgery do not seem to reduce the success of surgery.
S185
were poor oral tolerance. Future studies should be conducted to analyze reasons for readmissions so that interventions aimed at reducing readmissions can be implemented.
A5267
CORRELATES OF BARIATRIC SURGERY HOSPITAL READMISSIONS IN A HIGH VOLUME ACADEMIC MEDICAL CENTER Pablo Quadri; Mario Masrur; David Sigmon; Antonio Gangemi; Lisa Sanchez-Johnsen; Chandra Hassan; UIC, Chicago IL
THE EFFECTS OF CIRCULAR STAPLER HEIGHT ON ANASTOMOTIC COMPLICATIONS IN LAPAROSCOPIC ROUX EN Y GASTRIC BYPASS Kieran Purich1; Michael Horkoff2; Noah Switzer3; Shalvin Prasad2; Neal Church2; Xinzhe Shi3; Philip Mitchell2; Estifanos Debru2; Shahzeer Karmali3; Richdeep Gill2; 1University of Alberta, Sherwood Park Alberta; 2University of Calgary, Calgary AB; 3University of Alberta, Edmonton AB
Introduction: Hospital readmissions after bariatric surgery vary according to the surgical procedure but range from 0.5% to 11%. The primary aim of this study is to analyze the correlates of hospital readmissions, including the rate, reasons for hospital readmission and length of hospitalization for readmissions postbariatric surgery [sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB)] in our high volume academic medical center. The secondary aim is to analyze possible predisposing factors related to readmissions. Material and Methods: This is a retrospective study with 378 consecutive patients who underwent a minimally invasive SG or RYGB at the University of Illinois Hospital and Health Sciences System between June 2015 and September 2016. The following data was obtained: demographic characteristics, reason for readmissions, treatment received and length of hospitalization of the readmission. Additional factors related to readmissions will also be examined. Results: A total of 378 patients, 86.5% (n¼327) women and 13.5% (n¼51) men were included in the study. The mean age was 41.4 (SD¼11.4) years old and the mean body mass index at the time of the surgery was 49.3 (SD¼10). Surgeries were distributed and follows: 70.9% SG (265 laparoscopic and 3 robotic) and 29.1% RYGB (8 laparoscopic and 102 robotic). Conversion rate to open was 0.3% (n¼1). The mean operative time and length of hospitalization (LH) for SG and RYGB were 92.5 (SD¼31.4) and 159.0 (SD¼58.7) minutes, and 1.5 (SD¼0.7) and 1.7 (SD¼1.0) days respectively. The reoperation rate was 1.6% (n¼6). The 30-day readmission rates was 4.8% (n¼18). The causes of 30-day readmissions were related to: poor oral tolerance (n¼13, 72.5%), thrombotic thrombocytopenic purpura (n¼1, 5.5%), stroke (n¼1, 5.5%), deep venous thrombosis (n¼1, 5.5%), pulmonary embolism (n¼1, 5.5%) and gastroesophageal reflux (n¼1, 5.5%). The LH for 30-day readmissions was 3.2 (SD¼3.0) days. Of the patients who were readmitted, 55.6% (n¼10) were readmitted within the first week after discharge and the remaining 44.4% (n¼8) were readmitted after 1 week discharge. Additional analyses will be conducted to examine possible predisposing factors to readmissions. Conclusions: Hospital 30-day readmission rates in specialized high volume academic medical centers are an important area of concern and studies should be conducted to analyze reasons for readmissions so that interventions aimed at reducing readmissions can be implemented. The main causes of 30-day readmissions
Background: The laparoscopic Roux en Y gastric bypass (LRYGB) is accepted as the gold standard bariatric operation due to its efficacy and safety profile. Although a safe operation, the Roux en Y does have some morbid complications including: bleeding, stricturing requiring dilation and anastomotic leaks most commonly at the gastrojejunostomy (GJ) staple line. The circular stapler technique is a common method used to create the GJ anastomosis. The height of staples used vary by site and surgeon’s preference. Appropriate sized staples must be used for different tissues to provide appropriate tissue apposition while not inducing tissue ischemia and destruction. Recent studies have suggested that shorter circular stapler heights (3.5mm versus 4.8mm) are associated with fewer postoperative complications in the LRYGB including: lower stricture rates as well as a trend towards a lower incidence of postoperative anastomotic bleeds. This is thought to be related to improved tissue compression associated with the shorter staple height. These previous studies have acknowledged heterogeneity within their data, and slight variations exist within their surgical technique, stapler technology and timelines. These variables have potential to confound previous results. Methods: We completed a retrospective cohort study from the years 2015-2017 within the two primary sites (Edmonton and Calgary) of the Alberta Provincial Bariatric Program (APBP). These two sites preform a standardized LRYGB operation, which varies solely in circular stapler height. Only primary LRYGBs were considered. Results: We identified 214 patients who had underwent LRYGB, 143 in the 3.5mm circular stapler cohort, and 71 in the 4.8mm cohort. The two groups were similar in regards to age (46.3 years versus 44.3 years) and mean preoperative body mass index (46.0 versus 45.1). The rate of anastomotic stricturing requiring balloon dilation was lower in the 3.5mm stapler group in comparison to the 4.8mm stapler group, 3.5% versus 14.1% respectively (p¼0.008). In addition, the post-operative bleed rates requiring transfusion was significantly lower in the 3.5mm group, 6.3% versus 15.5% (p¼0.044). There was no difference in anastomotic leak rates and overall mortality between the two groups. Conclusions: Our data, within a homogenous and standardized obesity provincial network, supports the finding that there is a higher rate of anastomotic stricture and post operative bleeds with the use of a 4.8mm circular stapler in comparison to a 3.5mm circular stapler when forming a gastrojejunostomy in a laparoscopic Roux en Y gastric bypass.
A5266