Factors predicting the increased risk for return to the operating room in bariatric patients: A NSQIP database study

Kalyana C. Nandipati, Edward Lin, Farah Husain, Sebastian Perez, Jahnavi Srinivasan, John F. Sweeney, S. Scott Davis

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1172-1177
Number of pages6
JournalSurgical Endoscopy
Volume27
Issue number4
DOIs
StatePublished - Apr 2013

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Bariatrics
Operating Rooms
Databases
Morbidity
Mortality
Renal Insufficiency
Dialysis
Stomach
Hemorrhage
Population
Surgical Wound Infection
Bariatric Surgery
Gastric Bypass
Morbid Obesity
Wound Infection
Septic Shock
Quality Improvement
Pulmonary Embolism
Reoperation
Hematocrit

All Science Journal Classification (ASJC) codes

  • Surgery

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Factors predicting the increased risk for return to the operating room in bariatric patients : A NSQIP database study. / Nandipati, Kalyana C.; Lin, Edward; Husain, Farah; Perez, Sebastian; Srinivasan, Jahnavi; Sweeney, John F.; Davis, S. Scott.

In: Surgical Endoscopy, Vol. 27, No. 4, 04.2013, p. 1172-1177.

Research output: Contribution to journalArticle

Nandipati, Kalyana C. ; Lin, Edward ; Husain, Farah ; Perez, Sebastian ; Srinivasan, Jahnavi ; Sweeney, John F. ; Davis, S. Scott. / Factors predicting the increased risk for return to the operating room in bariatric patients : A NSQIP database study. In: Surgical Endoscopy. 2013 ; Vol. 27, No. 4. pp. 1172-1177.
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abstract = "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.",
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AU - Nandipati, Kalyana C.

AU - Lin, Edward

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AU - Perez, Sebastian

AU - Srinivasan, Jahnavi

AU - Sweeney, John F.

AU - Davis, S. Scott

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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.

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