TY - JOUR
T1 - Factors predicting the increased risk for return to the operating room in bariatric patients
T2 - A NSQIP database study
AU - Nandipati, Kalyana
AU - Lin, Edward
AU - Husain, Farah
AU - Perez, Sebastian
AU - Srinivasan, Jahnavi
AU - Sweeney, John F.
AU - Davis, S. Scott
PY - 2013/4
Y1 - 2013/4
N2 - Background: The objective of the study was to assess the risk factors associated with return to the operating room in bariatric surgery patients. Methods: Using the American College of Surgeons-National Surgical Quality Improvement Project's participant-use file, patients who underwent laparoscopic gastric bypass (LRYGB) and adjustable gastric band (LAGB) procedures for morbid obesity were identified. Several pre-, peri-, and postoperative variables, including 30 day morbidity and mortality, were collected. The study population was divided into two groups: patients returning to the operating room (group 1), and patients not returning to the operating room (group 2). Variables analyzed included postoperative complications, overall morbidity, and mortality. Relationships between preoperative and perioperative factors leading to the return to the operating room also were analyzed. Results: Of 28,241 (LRYGB = 18,671, LAGB = 9,570) patients included in the study, 644 (2.3 %) patients returned to the operating room. Of the study population, 30 day mortality rate was 0.13 % (37/28,241) and morbidity was 4.1 % (1,155/28,241). Patients returning to the operating room had a higher mortality [14/644 (2.2 %) vs. 23/27,597 (0.01 %); P < 0.001], and morbidity [258/644 (40 %) vs. 897/27,579 (3.3 %); P < 0.001] compared with those who did not return to the operating room. Postoperative complications (superficial wound infection, deep surgical site infection, organ space infection, pneumonia, pulmonary embolism, renal insufficiency, renal failure, septic shock, and length of stay) were significantly higher for patients who required reoperation. On multivariate logistic regression analysis, the bypass operation, bleeding disorder, patients on dialysis, preoperative hematocrit, preoperative low albumin, and length of operation were associated with increased risk of return to the operating room. Summary: In the bariatric population, return to the operating room is associated with significantly higher morbidity and mortality. Patients who are on dialysis, have a low preoperative serum albumin, and a history of bleeding disorders have a higher chance of return to the operating room. In addition, patients who have a long operation are at increased risk for return to the operating room. Increased awareness of these predictors will be helpful to counsel the patients before the operation.
AB - Background: The objective of the study was to assess the risk factors associated with return to the operating room in bariatric surgery patients. Methods: Using the American College of Surgeons-National Surgical Quality Improvement Project's participant-use file, patients who underwent laparoscopic gastric bypass (LRYGB) and adjustable gastric band (LAGB) procedures for morbid obesity were identified. Several pre-, peri-, and postoperative variables, including 30 day morbidity and mortality, were collected. The study population was divided into two groups: patients returning to the operating room (group 1), and patients not returning to the operating room (group 2). Variables analyzed included postoperative complications, overall morbidity, and mortality. Relationships between preoperative and perioperative factors leading to the return to the operating room also were analyzed. Results: Of 28,241 (LRYGB = 18,671, LAGB = 9,570) patients included in the study, 644 (2.3 %) patients returned to the operating room. Of the study population, 30 day mortality rate was 0.13 % (37/28,241) and morbidity was 4.1 % (1,155/28,241). Patients returning to the operating room had a higher mortality [14/644 (2.2 %) vs. 23/27,597 (0.01 %); P < 0.001], and morbidity [258/644 (40 %) vs. 897/27,579 (3.3 %); P < 0.001] compared with those who did not return to the operating room. Postoperative complications (superficial wound infection, deep surgical site infection, organ space infection, pneumonia, pulmonary embolism, renal insufficiency, renal failure, septic shock, and length of stay) were significantly higher for patients who required reoperation. On multivariate logistic regression analysis, the bypass operation, bleeding disorder, patients on dialysis, preoperative hematocrit, preoperative low albumin, and length of operation were associated with increased risk of return to the operating room. Summary: In the bariatric population, return to the operating room is associated with significantly higher morbidity and mortality. Patients who are on dialysis, have a low preoperative serum albumin, and a history of bleeding disorders have a higher chance of return to the operating room. In addition, patients who have a long operation are at increased risk for return to the operating room. Increased awareness of these predictors will be helpful to counsel the patients before the operation.
KW - Gastric bypass
KW - NSQIP
KW - Return to the operating room
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U2 - 10.1007/s00464-012-2571-2
DO - 10.1007/s00464-012-2571-2
M3 - Article
C2 - 23076457
AN - SCOPUS:84876285777
SN - 0930-2794
VL - 27
SP - 1172
EP - 1177
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 4
ER -