title: Determinants of resource utilization and outcomes in laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of 14,251 patients.
abstract: BACKGROUND
  Outcomes for patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery have improved, but a subset of patients who significantly utilize more resources exists. We identified preoperative variables that increase resource utilization in patients who undergo LRYGB.
  
  
  METHODS
  Patients who underwent LRYGB in 2007 and 2008 were identified from the NSQIP database. Variables that indicated resource utilization were operative time (OT), length of stay (LOS), and occurrence of postoperative complications. Analyses were performed by using multivariate analysis of variance and logistic regression.
  
  
  RESULTS
  Of 14,251 patients with a mean age of 44.6 (± 11.1) years, 19.4% were men. The national 30-day morbidity and mortality were 4.5% and 0.17%, respectively. The median OT was 128 min (interquartile range (IQR), 100-167), and the median LOS was 2 days (IQR, 2-3). Bleeding disorder, male gender, African American race, increasing weight, and age were significantly associated with increased OT (p < 0.05 for all). Severe chronic obstructive pulmonary disease, bleeding disorder, increasing age, and anesthesia time were associated with increased length of stay (p < 0.05). Preoperative dialysis dependence (odds ratio (OR), 8.5; 95% confidence interval (CI), 2.3-32.3) and dyspnea at rest (OR, 3.3; 95% CI, 1.7-6.3) were the greatest predictors of postoperative complications. Emergency case, bleeding disorder, prior percutaneous coronary intervention, and increasing operative time also were significantly associated with increased postoperative complications on multivariate logistic regression analysis (p < 0.05 for all).
  
  
  CONCLUSIONS
  Age, sex, race, obesity, and some medical comorbidities affect outcomes and increase resource utilization. Optimization of modifiable factors and careful patient selection are needed to facilitate further improvement in outcomes and resource utilization.
authors.affiliation: Department of Surgery, Creighton University Medical Center, Omaha, NE 68131, USA.
authors.forename: Prateek K
authors.initials: PK
authors.lastname: Gupta
authors.forename: Weldon J
authors.initials: WJ
authors.lastname: Miller
authors.forename: Jyothsna
authors.initials: J
authors.lastname: Sainath
authors.forename: R Armour
authors.initials: RA
authors.lastname: Forse
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D015999:Multivariate Analysis; D016896:Treatment Outcome