Ambulatory Laparoscopic Roux-En-Y Gastric Bypass
This study is based on analysis of data from the BOLD (Bariatric Outcomes Longitudinal Database). As described in greater detail elsewhere, participants in the ASMBS-BSCOE program are required to enter prospective data into the BOLD for all bariatric surgical patients collected during preoperative visits, the hospital stay, and at all postoperative visits. BOLD data are used to monitor compliance with the requirements of the BSCOE program and to support quality improvement for the surgical treatment of obesity and its associated conditions. The Copernicus Group Independent Review Board approved the use of BOLD data for research and the BOLD study has been registered with the National Institutes of Health (NCT01002352).
The baseline data used in the present study consisted of age, sex, race, insurance status, body mass index (BMI), excess body weight, and the status of several cardiometabolic, psychosocial, and general comorbidities including diabetes, hypertension, lipids, asthma, gastroesophageal reflux disorder, depression, and psychosocial impairment. Comorbidity severity was assessed through a modified version of a scoring system to evaluate obesity-related conditions in bariatric surgical patients. The intraoperative data used in the present study included the procedure performed and surgical approach. The primary outcomes monitored were mortality, serious complications, and hospital readmissions that occurred within 30 days of surgery.
The standard definition of an ambulatory LOS is that the patient is discharged on the same day as the surgery, usually from the postanesthetic care unit or after a brief observation after surgery of 2 to 4 hours. A 1-day LOS generally refers to a patient who stays overnight but is discharged the following morning, generally within 23 hours and 59 minutes of the conclusion of the operative procedure. For some payers, a 1-day LOS is considered outpatient surgery. Of note, the discharge time is usually denoted by the time when a physician order for discharge is written. In this article, short-stay LRYGB is either an ambulatory or 1-day LOS.
The study included patients aged 18 to 75 years with BMI of 35 kg/m or more who had an LRYGB surgery performed by a participant in the ASMBS-BSCOE program between June 2007 and October 2010. After applying patient exclusions, there were 54,908 patients who met inclusion criteria (Fig. 1). All LRYGB procedures were stratified on the basis of LOS to compare 30-day outcomes of mortality, serious complications, and hospital readmissions. The categories for LOS were defined as 0 (ambulatory), 1, 2, 3, or 4 days. Patients with an LOS of more than 4 days were excluded from the regression analysis because their prolonged LOS was likely to be due to extenuating circumstances that were not the subject of this study. Serious complications were defined as a composite that included the following complications: death, anastomotic leakage, cardiac arrest, deep venous thrombosis, evisceration, heart failure and/or pulmonary edema, liver failure, myocardial infarction, pneumothorax, pulmonary embolism, renal failure, respiratory failure, sepsis, systemic inflammatory response, cerebrovascular accident, and bleeding requiring blood transfusion.
(Enlarge Image)
Figure 1.
Study design algorithm. Pop indicates population; exc., exclusion.
Group means for variables stratified by LOS were compared by using the Kruskal-Wallis test for nonparametric populations by 1-way analysis of variance, with P < 0.05 set as significant. Multivariate logistic regression analyses were performed for all outcomes including 30-day mortality, serious complications, and readmissions as the dependent variables. In all multivariate logistic regression analyses, the independent variables were age (<50 years as reference), sex (female as reference), race (white as reference), BMI (<50 kg/m as reference), insurance (private as reference), number of comorbidities (<5 as reference), and LOS (2 days as reference). The regression analyses included unadjusted, adjusted for dependent variables, and adjusted for all significant dependent variables.
Methods
This study is based on analysis of data from the BOLD (Bariatric Outcomes Longitudinal Database). As described in greater detail elsewhere, participants in the ASMBS-BSCOE program are required to enter prospective data into the BOLD for all bariatric surgical patients collected during preoperative visits, the hospital stay, and at all postoperative visits. BOLD data are used to monitor compliance with the requirements of the BSCOE program and to support quality improvement for the surgical treatment of obesity and its associated conditions. The Copernicus Group Independent Review Board approved the use of BOLD data for research and the BOLD study has been registered with the National Institutes of Health (NCT01002352).
Data Definitions
The baseline data used in the present study consisted of age, sex, race, insurance status, body mass index (BMI), excess body weight, and the status of several cardiometabolic, psychosocial, and general comorbidities including diabetes, hypertension, lipids, asthma, gastroesophageal reflux disorder, depression, and psychosocial impairment. Comorbidity severity was assessed through a modified version of a scoring system to evaluate obesity-related conditions in bariatric surgical patients. The intraoperative data used in the present study included the procedure performed and surgical approach. The primary outcomes monitored were mortality, serious complications, and hospital readmissions that occurred within 30 days of surgery.
The standard definition of an ambulatory LOS is that the patient is discharged on the same day as the surgery, usually from the postanesthetic care unit or after a brief observation after surgery of 2 to 4 hours. A 1-day LOS generally refers to a patient who stays overnight but is discharged the following morning, generally within 23 hours and 59 minutes of the conclusion of the operative procedure. For some payers, a 1-day LOS is considered outpatient surgery. Of note, the discharge time is usually denoted by the time when a physician order for discharge is written. In this article, short-stay LRYGB is either an ambulatory or 1-day LOS.
The study included patients aged 18 to 75 years with BMI of 35 kg/m or more who had an LRYGB surgery performed by a participant in the ASMBS-BSCOE program between June 2007 and October 2010. After applying patient exclusions, there were 54,908 patients who met inclusion criteria (Fig. 1). All LRYGB procedures were stratified on the basis of LOS to compare 30-day outcomes of mortality, serious complications, and hospital readmissions. The categories for LOS were defined as 0 (ambulatory), 1, 2, 3, or 4 days. Patients with an LOS of more than 4 days were excluded from the regression analysis because their prolonged LOS was likely to be due to extenuating circumstances that were not the subject of this study. Serious complications were defined as a composite that included the following complications: death, anastomotic leakage, cardiac arrest, deep venous thrombosis, evisceration, heart failure and/or pulmonary edema, liver failure, myocardial infarction, pneumothorax, pulmonary embolism, renal failure, respiratory failure, sepsis, systemic inflammatory response, cerebrovascular accident, and bleeding requiring blood transfusion.
(Enlarge Image)
Figure 1.
Study design algorithm. Pop indicates population; exc., exclusion.
Statistical Analysis
Group means for variables stratified by LOS were compared by using the Kruskal-Wallis test for nonparametric populations by 1-way analysis of variance, with P < 0.05 set as significant. Multivariate logistic regression analyses were performed for all outcomes including 30-day mortality, serious complications, and readmissions as the dependent variables. In all multivariate logistic regression analyses, the independent variables were age (<50 years as reference), sex (female as reference), race (white as reference), BMI (<50 kg/m as reference), insurance (private as reference), number of comorbidities (<5 as reference), and LOS (2 days as reference). The regression analyses included unadjusted, adjusted for dependent variables, and adjusted for all significant dependent variables.
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