Risk factors for post-operative mortality in bariatric surgery.
BACKGROUND
Appropriate patient selection is crucial to the success of bariatric surgery (BaS). The objective of this study was to identify risk factors for increased post-operative mortality in patients undergoing BaS using a nationally representative sample.


METHODS
BaS patients > or = 18 years old in the United States were identified from the 2001 Nationwide Inpatient Sample (NIS). The effect of gender, age, insurance status, and need for re-operation on post-operative mortality was examined using a multivariate logistic regression model.


RESULTS
A national cohort of 54,878 patients was identified with age 41 +/- 0.2 years (mean +/- SE), 84% women, length of stay (LOS) 3.9 +/- 0.2 days, and overall mortality of 4 per 1,000 BaS patients. Mean LOS of those who died was 17.6 +/- 3.7 days. Adjusting for comorbidities and demographics, men had increased likelihood of death [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.1-4.3, P < 0.05]. Compared to younger patients, those aged above 39 years had over two-fold risk of death [ages 40-49: OR 2.6, 95% CI 1.1-6.5, P < 0.05; ages 50-59: OR 4.3, 95% CI 1.7-11, P < 0.05]. Medicaid patients [OR 4.7, 95% CI 1.2-13, P < 0.05 compared to privately insured] and those requiring re-operation [OR 22, 95% CI 5.4-88, P < 0.05] had higher odds of dying.


CONCLUSIONS
Based on national data, risk factors for increased post-operative mortality in BaS patients include male gender, age > 39 years, Medicaid insured, and need for re-operation. These data can assist in optimizing BaS patient outcomes.
Poulose
Benjamin K
BK
Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. benjamin.poulose@vanderbilt.edu
Griffin
Marie R
MR
Moore
Derek E
DE
Zhu
Yuwei
Y
Smalley
Walter
W
Richards
William O
WO
Wright
J Kelly
JK
Melvin
Willie
W
Holzman
Michael D
MD
D000328:Adult; D049088:Bariatrics; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D014481:United States