Variation in Outcomes for Bariatric Surgery by Procedure
John Morton, *Miranda Moore, *Joseph Canner, *Eric Schneider
Surgey, Yale, Madison, CT, United States.
Introduction
Bariatric surgery has undergone change in choice of procedure over time. The aim of this study is to determine comparative outcomes for contemporary bariatric surgery.
Methods
The Nationwide Readmissions Database from 2018-2020 was utilized to capture laparoscopic sleeve gastrectomy (SG), gastric bypass (GB), and duodenal switch (DS) procedures via ICD-10/DRG codes for 266,743 procedures from 1947 hospitals. Demographics and outcomes were compared by procedure. Outcomes were risk-adjusted by age, gender, and Elixhauser Index (comorbidity index) and included outcomes of Patient Safety Indicator (PSI) 90 (composite measure of post-operative complications) and mortality.
Results
The algorithm yielded results for SG (69.3%) n=184,863 procedures; GB (29%) n=77,269 procedures; and DS(1.7%) n=4,611. Overall average demographics revealed 81.2% female, 43 years, 61% private insurance, 1.4 Elixhauser score, 1.8 Days Length of Stay, and 97.9% Discharge to Home. Hospital bedsize composition was as follows: small (17.7%), medium (29.5%), and large (52.8%). Overall combined mortality and presence of PSI-90 was 0.36. Combined mortality and presence of PSI-90 by procedure was as follows: SG (0.25%), GB (0.57 %), DS (0.36%), p<0.001. For specific postop PSI rates, there was continued variation with SG lowest, GB intermediate, and DS highest including hemorrhage (SG 0.11, GB 0.23, DS 0.33); respiratory failure (SG 0.07, GB 0.17, DS 0.29); venous thrombotic event (SG 0.03, GB 0.05, DS 0.11); sepsis (SG 0.04, GB 0.16, DS 0.38); and mortality (SG 0.02, GB 0.03, DS 0.09) p<0.001.
Conclusion
In this nationally representative database, there was significant variation in outcomes for hospitals performing bariatric surgery with adverse events for SG lowest, GB intermediate, and DS highest.
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