An analysis of readmission trends by urgency and race/ethnicity in the MBSAQIP registry, 2015-2018

Background: Large-scale analyses stratifying bariatric surgery readmissions by urgency are lacking. Objectives: Identify predictors of urgent/nonurgent readmission among ideal bariatric candidates, using a national registry. Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database. Methods: We extracted an ideal patient cohort from the 2015-2018 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) registry, characterized by only typical weight-related comorbidities (hypertension [HTN], obstructive sleep apnea [OSA], gastroesophageal reflux disease [GERD], and diabetes (insulin-dependent diabetes mellitus [IDDM] and non-insulin-dependent diabetes mellitus [NIDDM]) undergoing primary bariatric surgery with an uneventful postoperative course. Readmissions were classified as urgent (UR; e.g., leak, obstruction, bleeding) or nonurgent (NUR; e.g., dehydration, nonspecific abdominal pain). chi(2) or t test analyses were used for bivariate significance testing. Multivariate logistic regression models were constructed to assess independent predictors of readmission. Results: The cohort (N = 292,547) comprised 38.5% of all MBSAQIP patients (mean age [standard deviation] = 43.2 [11.7]; body mass index [BMI] = 44.9 [6.6]; 81% female; 62% White, 17% Black, 14% Hispanic). Total readmission rates were 2.75% (n = 8046) and decreased from 2015-2018 (3.00%-2.63%; P < .001). Independent predictors of readmissions included Roux-en-Y gastric bypass (RYGB) (odds ratio [OR] = 1.97, p < .001), Black (OR = 1.46, P < .001) and Hispanic race (OR = 1.14, P < .001), GERD (OR = 1.27, P < .001), HTN (OR = 1.08, P = .003), and IDDM (OR = 1.39, P < .001). NUR and UR readmission rates were 1.27% (n = 3702) and 1.06% (n = 3090), respectively. NURs decreased over time (1.42%-1.16%, P < .001), with no change in Urs (1.01%-1.06%, P = .51); this trend persisted in multivariate analysis (2017: NUR OR = .85, P < .001; 2018: NUR OR = .82, p < .001). Independent predictors of both URs and NURs included Black (NUR OR = 1.71, p < .001; UR OR = 1.27, p < .001) and Hispanic (NUR OR = 1.15, P < .001; UR OR = 1.19, P < .001) race, RYGB (NUR OR = 1.84, P < .001; UR OR = 2.34, P <.001), and GERD (NUR OR = 1.39, p < .001; UR OR = 1.17, P <.001). Female sex (NUR OR = 1.64, P <.001), age (NUR OR = .98, P <.001), HTN (NUR OR = 1.22, P <.001), and IDDM (NUR OR = 1.41, P < .001) predicted NURs, while higher BMI (UR OR = 1.01, P < .001), and OSA (UR OR = 1.10, P = .02) predicted URs. Conclusion: Readmission rates for ideal bariatric patients improved over time, driven by reductions in non-urgent etiologies. Racial disparities persist for both urgent and non-urgent causes of readmission. (C) 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Automated summary

The study found that readmission rates for ideal bariatric patients improved over time, mainly driven by reductions in non-urgent causes. Racial disparities persist for both urgent and non-urgent causes of readmission.