30-day readmissions after sleeve gastrectomy versus Roux-en-Y gastric bypass.

BACKGROUND: Laparoscopic sleeve gastrectomy (SG) is gaining popularity over laparoscopic Roux-en-Y gastric bypass (LRYGB) within the United States. Data on readmissions after bariatric procedures are mostly based on LRYGB, with limited evidence regarding etiology of readmissions after SG.

OBJECTIVES: The aim of this study was to compare 30-day readmission rate and etiology after SG and LRYGB.

SETTING: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) participating facilities

METHODS: Patients undergoing elective laparoscopic SG and LRYGB in 2012 and 2013 were identified from the ACS-NSQIP Participant Use Data File. Demographic characteristics, co-morbidities, and 30-day readmissions were analyzed. Multivariable logistic regression analysis evaluated variables with P<.1, using readmission as the dependent variable.

RESULTS: A total of 34,983 patients underwent bariatric surgery (46.0% SG, 54.0% LRYGB). Readmission was reported in 1773 (5.1%) patients. Readmission was more common after LRYGB compared with SG (6.1% versus 3.8%, P<.001, adjusted OR 1.59, 95% CI 1.44-1.76, P<.001). Nausea, vomiting, and dehydration were more commonly a reason for readmission after SG than LRYGB (30.4% versus 18.8%, P =<.001). Additionally, venous thromboembolism was a more frequent readmission cause for SG compared with LRYGB patients (7.2% versus 3.6%, P = .002). Postoperative pain, bleeding, intestinal obstructions, and wound occurrences were more commonly a readmission cause for LRYGB compared with SG.

CONCLUSIONS: Hospital readmissions are more common after LRYGB than SG. Reasons for readmission differ between procedures. Given the progressive increase in the proportion of bariatric patients undergoing SG, hospital programs that aim to decrease readmissions after bariatric surgery need to focus on prevention and control of postoperative nausea and dehydration.