S1209 Incidence and Predictors of 30-Day All Cause Readmission in Patients Undergoing Bariatric Surgery: A Nationwide Analysis

INTRODUCTION: Morbid obesity has become of the most critical public health crisis in the western world. Among various therapeutic options, Bariatric Surgery (BS) is now considered one of the most effective method of weight loss. Previous studies have estimated the 30-day all-cause readmission after BS to be 1.2%–5.8%. We decided to perform an analysis using the most recent Nationwide Readmission Database (NRD) to look at 30-day all-cause readmission and independent predictors of readmission. METHODS: We queried the 2017 Nationwide Readmission Database (NRD) using ICD-10-CM diagnosis codes to identify all adult patients who underwent BS from January to November 2017. Outcomes assessed were 30-day readmission rates, mortality, length of stay (LOS) and hospitalization costs. A multivariate cox regression was done to identify independent predictors of readmission. Statistical analysis was performed using STATA software. RESULTS: A total of 182,848 adult patients underwent BS during hospitalization in 2017, with in-hospital mortality rate of 0.52% (951). Of the patients discharged alive, 4.99% (9,088) patients were readmitted within 30-days. The most common primary diagnosis at readmission was “Other complications of other bariatric surgery.” When compared to index admission, readmitted patients had higher in-hospital mortality (0.52% vs 2.06%, P < 0.01), increased mean LOS ( 2.94 days vs 5.94 days, P < 0.01) but lower mean hospitalization charges ( $67,763 vs $66,065, P < 0.01). Readmission added 54,000 inpatient days and $143 million in hospitalization cost to the healthcare burden. Higher Charlson comorbidity score (HR 1.15, P < 0.01), age 40-59 years (HR 1.11, P < 0.01), longer LOS and AKI (HR 1.27, P < 0.01) were associated with higher likelihood of 30-day readmission, whereas diabetes mellitus (HR 0.87, P < 0.01), insurance other than Medicare [Medicaid (HR 0.82, P < 0.01), Private (HR 0.62, P < 0.01] (HR 0.78, P < 0.01) were associated with decreased likelihood of 30-day readmission. CONCLUSION: In the US, almost 5% patients undergoing BS are readmitted within 30 days of discharge. Readmission is associated with significantly increased in-hospital mortality, LOS, and lower hospitalization charges. AKI, higher comorbidity burden, age 40-59 years and longer LOS were independent predictors of readmission. Further studies are needed to assess the high-risk populations to understand the reasons predisposing to early readmission.Figure 1.: 30-day readmission after Bariatric Surgery.