AbuHasan Qais, Airhart Austin E, Ross-Driscoll Katie, Stefanidis Dimitrios, Yuce Tarik K
Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
The Regenstrief Institute, Indianapolis, IN, USA.
Obes Surg. 2025 Sep 16. doi: 10.1007/s11695-025-08240-6.
Following the recent Centers for Medicare and Medicaid Services proposal to classify several bariatric operations as outpatient procedures, there has been renewed interest in the factors that influence patients' postoperative lengths of stay (LOS). Multiple patient- and procedural factors associated with LOS following bariatric surgery have been studied, but the impact of patient distance from the hospital remains poorly understood. Therefore, we aimed to determine the impact of patient distance from the hospital on LOS, readmissions, and postoperative complications.
Patients who underwent bariatric surgery at an accredited high-volume bariatric center from 2016 to 2022 were identified. Patients were compared according to travel distance, utilizing continuous distance as well as quartiles. Outcomes of interest included prolonged LOS (≥2 days), 30-day readmissions, and complications. Associations between patient distance from the hospital and outcomes were evaluated by calculating a linear correlation coefficient as well as fitting multivariable logistic regression models adjusting for patient and procedural factors and clustered at the surgeon level.
A total of 1510 patients underwent bariatric surgery and traveled a median of 20.6 miles (IQR: 13.3-55.8). Of included patients, 799 (52.9%) were discharged by the end of postoperative day 1. The overall 30-day readmission rate was 5.9% (n = 89) and the overall rate of 30-day complications was 7.3% (n = 110). There was no linear relationship between the continuous distance and LOS (correlation coefficient: 0.013, p = 0.608). On multivariable analysis, patient travel distance was not associated with prolonged LOS (Q4 vs. Q1: 47.3% vs. 47.4%, aOR:1.25, 95% CI: 0.83-1.87), readmissions (Q4 vs. Q1: 6.4% vs. 5.9%, aOR: 1.16, 95% CI: 0.45-2.98), or complications (Q4 vs. Q1: 7.5% vs. 5.9%, aOR: 1.30, 95% CI: 0.78-2.16).
Postoperative LOS is one of several important factors in determining the classification between inpatient and outpatient status. In this evaluation, patient travel distance was not associated with total LOS after bariatric surgery, prolonged LOS, 30-day postoperative readmissions, or complications. Nearly half of the patients required hospital stays of 2 days, suggesting that current proposals to classify bariatric surgery as an outpatient procedure may need reconsideration.
继美国医疗保险和医疗补助服务中心最近提议将几种减肥手术归类为门诊手术之后，人们重新关注影响患者术后住院时间（LOS）的因素。已经对减肥手术后与住院时间相关的多个患者和手术因素进行了研究，但患者与医院的距离所产生的影响仍知之甚少。因此，我们旨在确定患者与医院的距离对住院时间、再入院率和术后并发症的影响。
确定2016年至2022年在一家经认可的高容量减肥中心接受减肥手术的患者。根据出行距离对患者进行比较，采用连续距离以及四分位数。感兴趣的结果包括住院时间延长（≥2天）、30天再入院率和并发症。通过计算线性相关系数以及拟合多变量逻辑回归模型来评估患者与医院的距离和结果之间的关联，该模型对患者和手术因素进行了调整，并在外科医生层面进行了聚类。
共有1510例患者接受了减肥手术，出行中位数为20.6英里（四分位距：13.3 - 55.8）。纳入的患者中，799例（52.9%）在术后第1天结束时出院。总体30天再入院率为5.9%（n = 89），总体30天并发症发生率为7.3%（n = 110）。连续距离与住院时间之间没有线性关系（相关系数：0.013，p = 0.608）。在多变量分析中，患者出行距离与住院时间延长无关（四分位数4 vs. 四分位数1：47.3% vs. 47.4%，调整后比值比：1.25，95%置信区间：0.83 - 1.87）、再入院率无关（四分位数4 vs. 四分位数1：6.4% vs. 5.9%，调整后比值比：1.16，95%置信区间：0.45 - 2.98）或并发症无关（四分位数4 vs. 四分位数1：7.5% vs. 5.9%，调整后比值比：1.30，95%置信区间：0.78 - 2.16）。
术后住院时间是决定住院和门诊状态分类中的几个重要因素之一。在本评估中，患者出行距离与减肥手术后的总住院时间、住院时间延长、术后30天再入院率或并发症无关。近一半的患者需要住院2天，这表明目前将减肥手术归类为门诊手术的提议可能需要重新考虑。
