Background
Readmission after bariatric surgery is a quality improvement target, but no MBSAQIP analyses have studied the significance of readmission urgency, particularly for low-risk patients. Therefore, we identified straightforward patients and ascertained readmission trends by degree of urgency, over time and by race/ethnicity.
Methods
Patients with only typical weight-related comorbidities (e.g., hypertension, obstructive sleep apnea, diabetes, gastroesophageal reflux) who underwent primary sleeve gastrectomy(SG) or Roux-en-Y-gastric-bypass(RYGB) between 2015-2018, with an uneventful postoperative course, were identified. Readmissions were classified as 'Urgent'(e.g., leak, obstruction, bleeding) or 'Nonurgent'(e.g., dehydration, nonspecific abdominal pain). Chi-squared or T-test analyses were used for bivariate significance testing. Multivariate logistic regression models were constructed to assess independent predictors of readmission.
Results
Our sample(N=404,377) of straightforward cases comprised 53% of the MBSAQIP registry(Female:81%; SG:75%; Non-Hispanic-White:62%, Black/African-American:17%, Hispanic: 14%). Overall readmission rate was 2.85%(n=11,512) and decreased from 2015-2018(3.20% to 2.68%;p<0.0001). Nonurgent readmission rate was 1.30%(n=5,253) and decreased from 2015-2018(1.44% to 1.17%,p<0.0001). Black(OR 1.47,p<0.0001) and Hispanic(OR 1.15,p<0.0001) race/ethnicity were independent predictors of readmission. Readmissions overall became progressively less likely in 2016(OR 0.93,p=0.006), 2017(OR 0.87, p<0.0001), and 2018(OR 0.86, p<0.0001). Black(OR 1.80,P<0.0001) and Hispanic(OR 1.18,p<0.0001) race/ethnicity predicted non-urgent readmission. Non-urgent readmissions became less likely in 2017(OR 0.87,p<0.0001) and 2018(OR 0.83,p<0.0001), but urgent readmissions did not trend similarly.
Conclusions
Readmission rates for straightforward primary bariatric patients from 2015 to 2018 reveal an improvement in readmission rates, but racial disparities persist. Improvements appear to be driven by reductions in non-urgent readmissions.