Risk factors for readmission for early small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: an MBSAQIP analysis

Usah Khrucharoen; Yen-Yi Juo; Thongsak Wongpongsalee; Yijun Chen; Erik P Dutson

doi:10.1016/j.soard.2021.02.031

Risk factors for readmission for early small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: an MBSAQIP analysis

Surg Obes Relat Dis. 2021 Jun;17(6):1041-1048. doi: 10.1016/j.soard.2021.02.031. Epub 2021 Mar 8.

Authors

Usah Khrucharoen¹, Yen-Yi Juo¹, Thongsak Wongpongsalee², Yijun Chen³, Erik P Dutson⁴

Affiliations

¹ Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California; Center for Obesity and Metabolic Health, University of California, Los Angeles, California; Center for Advanced Surgical & Interventional Technology, University of California, Los Angeles, California.
² Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California; Center for Advanced Surgical & Interventional Technology, University of California, Los Angeles, California; Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³ Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California; Center for Obesity and Metabolic Health, University of California, Los Angeles, California.
⁴ Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California; Center for Obesity and Metabolic Health, University of California, Los Angeles, California; Center for Advanced Surgical & Interventional Technology, University of California, Los Angeles, California. Electronic address: edutson@mednet.ucla.edu.

PMID: 33965351
DOI: 10.1016/j.soard.2021.02.031

Abstract

Background: Small bowel obstruction (SBO) following laparoscopic Roux-en-Y gastric bypass (LRYGB) is associated with significant morbidity.

Objectives: To evaluate the rate of and risk factors for readmission for SBO within 30 days of LRYGB.

Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited centers.

Methods: This is a retrospective study using the MBSAQIP database. A query was performed from 2015-2018 for patients who underwent LRYGB and required readmission for SBO. Those who had a reoperation, intervention, readmission, or expired from causes other than SBO were excluded. Descriptive, bivariate, and binary logistic regression analyses were performed.

Results: Among 184,660 patients undergoing LRYGB, 1189 (.64%) required readmission due to SBO. Among the readmission cases, 978 (82.5%) were identified as having intestinal obstruction (unspecified), 108 (9.1%) incisional hernia, and 100 (8.4%) internal hernia. Among these cases, 69% had a reoperation and 1.3% expired during the 30-day period. From a logistic regression model, parameters independently associated with an increased risk for readmission for early SBO include being female (adjusted odds ratio [AOR], 1.53) or black (AOR, 1.41) and having gastroesophageal reflux (AOR, 1.35), a history of myocardial infarction (AOR, 1.76), a history of deep vein thrombosis (AOR, 1.73), previous obesity surgery/foregut surgery (AOR, 1.79), a robotic-assisted procedure (AOR, 1.23), concurrent hiatal hernia repair (AOR, 1.66) and adhesiolysis (AOR, 1.42).

Conclusion: The rate of readmission for early SBO following LRYGB was less than 1%. The majority of these cases required reoperation. The increased intraoperative complexity of LRYGB is associated with an increased risk of readmission due to early SBO.

Keywords: Intestinal obstruction; Laparoscopic; Risk factors; Roux-en-Y gastric bypass.

MeSH terms

Accreditation
Bariatric Surgery*
Female
Gastric Bypass* / adverse effects
Humans
Intestinal Obstruction* / etiology
Intestinal Obstruction* / surgery
Laparoscopy* / adverse effects
Obesity, Morbid* / surgery
Patient Readmission
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Quality Improvement
Retrospective Studies
Risk Factors
Treatment Outcome