title: Hospital admissions greater than 30 days following bariatric surgery: patient and procedure matter.
abstract: BACKGROUND
  Assessment of hospital admission in the 30-day period following bariatric surgery likely underestimates true hospital utilization. The purpose of this study is to assess hospital admissions for 2 years following bariatric surgery to identify potential differences by patient and procedure.
  
  
  METHODS
  New York State Planning and Research Cooperative System (SPARCS) longitudinal administrative data were used to identify 22,139 adult patients who underwent a primary bariatric surgery from 2006 to 2008. Bariatric operations included laparoscopic gastric banding (LGB), laparoscopic Roux-en-y gastric bypass (RYGB), and laparoscopic sleeve gastrectomy (LSG). Patients were followed for 2 years after surgery to identify all-cause hospital admissions. Statistical correlation between postoperative hospital admission and patient demographics, comorbid conditions, and bariatric procedure was performed.
  
  
  RESULTS
  Of the 22,139 patients, 5,718 (26 %) patients were admitted within 2 years of surgery for a total of 9,502 admissions. Thirty-day admission rate was 5 %. The number of admissions per patient ranged from 1 to 22. Assessing the number of admissions per patient demonstrated that 3,741 (17 %) patients had one, 1,575 (7 %) had 2-3, and 402 (2 %) patients had greater than 4 admissions. LSG had both the highest admission rate and percentage of patients with >4 admissions, followed by RYGB and then LGB (p < 0.001). Risk factors for admission included black race, female gender, age > 50, Medicaid/Medicare as payer, congestive heart failure, pulmonary disease, diabetes, rheumatoid arthritis, history of substance abuse, and psychoses/depression.
  
  
  CONCLUSIONS
  One out of four bariatric patients will be admitted to the hospital within 2 years of surgery. While most patients are admitted only once, a subset of patients requiring numerous hospital admissions was identified. LSG is associated with both the highest rate as well as highest frequency of hospital admissions. Several patient factors were also identified that significantly increased admission risk. Consideration and attention to these factors are necessary for operative planning, preoperative patient education, and postoperative monitoring.
authors.affiliation: Division of Bariatric and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA, dana.telem@stonybrookmedicine.edu.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.forename: Foster
authors.initials: F
authors.lastname: Gesten
authors.forename: Wendy
authors.initials: W
authors.lastname: Patterson
authors.forename: Brittany
authors.initials: B
authors.lastname: Peoples
authors.forename: Gerald
authors.initials: G
authors.lastname: Gracia
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.forename: Qiao
authors.initials: Q
authors.lastname: Zhang
authors.forename: Maria
authors.initials: M
authors.lastname: Altieri
authors.forename: Aurora D
authors.initials: AD
authors.lastname: Pryor
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology*; D013997:Time Factors; D014481:United States / Q000453:epidemiology