Kachmar Michael, Gunaldo John M, Doiron Jake E, Corpodean Florina, Danos Denise M, Galvani Carlos, Cook Michael W, Schauer Philip R, Albaugh Vance L
Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, LA, USA.
Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Surg Endosc. 2025 May 16. doi: 10.1007/s00464-025-11799-x.
Recently, same-day Metabolic Surgery (MS) has gained traction, especially to reduce costs and hospital resource utilization. While shorter hospital stays are desirable, accelerated discharge could increase postoperative burden for those patients at risk. This study evaluated whether specific patient characteristics are associated with increased 30-day readmission rates and number of readmissions as a potentially identifying those less suited for same-day discharge.
Using the MBSAQIP (2015-2021), 960,757 cases of primary minimally invasive sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch (DS) were included. Readmission characteristics were extracted from ancillary Participant Use Files (PUF) and linked to the main MBSAQIP data. Zero-inflated Poisson (ZIP) models assessed associations between preoperative patient characteristics and readmission risk. The two-stage models analyzed odds of any 30-day readmission and calculated the relative risk (RR) of multiple readmissions.
Several key predictors of single as well as multiple readmissions in the first 30 days following intervention were noted. Black or Hispanic race, BMI, diabetes, COPD, GERD, and therapeutic anticoagulation were associated with increased odds of readmission likelihood after MS. Black race and GERD predicted increased readmission frequency (multiple readmissions) among all readmission cases, while those aged ≥ 40 years and Hispanic race were less likely to require multiple readmissions.
This large-scale MS analysis highlights patient characteristics that should be carefully considered by MS providers during patient counseling and consideration of same-day discharge. Readmission poses significant financial, physiological, and psychological burdens emphasizing the need for careful patient evaluation and counseling, particularly for those at higher risk, to optimize patient outcomes in the context of accelerated discharge protocols.
最近，当日代谢手术（MS）受到了关注，特别是在降低成本和医院资源利用方面。虽然缩短住院时间是理想的，但加速出院可能会增加有风险患者的术后负担。本研究评估了特定的患者特征是否与30天再入院率增加和再入院次数相关，以此作为潜在识别那些不太适合当日出院患者的方法。
使用MBSAQIP（2015 - 2021年），纳入了960,757例原发性微创袖状胃切除术（SG）、Roux - Y胃旁路术（RYGB）和十二指肠转位术（DS）的病例。从辅助参与者使用文件（PUF）中提取再入院特征，并将其与主要的MBSAQIP数据相链接。零膨胀泊松（ZIP）模型评估术前患者特征与再入院风险之间的关联。两阶段模型分析了30天内任何再入院的几率，并计算了多次再入院的相对风险（RR）。
注意到了干预后前30天内单次和多次再入院的几个关键预测因素。黑人或西班牙裔种族、体重指数、糖尿病、慢性阻塞性肺疾病（COPD）、胃食管反流病（GERD）和治疗性抗凝与MS后再入院可能性增加的几率相关。黑人种族和GERD预测了所有再入院病例中再入院频率增加（多次再入院），而年龄≥40岁的患者和西班牙裔种族患者需要多次再入院的可能性较小。
这项大规模的MS分析突出了MS提供者在患者咨询和当日出院考虑过程中应仔细考虑的患者特征。再入院带来了重大的经济、生理和心理负担，强调需要对患者进行仔细评估和咨询，特别是对那些风险较高的患者，以便在加速出院方案的背景下优化患者结局。
