Background

With continued demonstration of the safety of outpatient metabolic surgery (MS) for some individuals, identifying patients at risk for readmissions, reoperations, and non-operative intervention (i.e. inpatient postoperative-care (IP-POC)) becomes critical. IP-POC not only increases patient morbidity, but incurs significant costs that can average >$15,000 per readmission. Identifying patient characteristics associated with IP-POC can inform clinical practice and heightened surveillance of at-risk patients. Using a weighted IP-POC score, we hypothesized that certain patient characteristics would be associated with increased IP-POC incidence and severity.

Methods

Examining 1,346,468 MBSAQIP records (2015-2021), 973,520 cases of primary laparoscopic SG, RYGB, and DS were identified. Conversions, pediatric cases, and <30 day follow-up were excluded. IP-POC severity scores were computed by summing readmissions-(1), interventions-(5), and reoperations-(15). Risk factors were identified using zero-inflated Poisson models and ROC analysis for mortality and comorbidity thresholds.

Results

Simple and multivariable (Table 1) ZIP models demonstrated: Male sex had a higher likelihood (OR 1.11) and higher severity of IP-POC (RR 1.15). Black patients were less likely to require (OR 0.69) and had less severe (RR 0.86) IP-POC. COPD, GERD, and smokers had lower IP-POC likelihood but higher severity [all p<0.001]. ROC analysis identified weighted IP-POC thresholds of >= 6 for MACE (OR 2.4) and >= 10 for 30-day mortality (OR 4.7).

Conclusions

Weighted-severity analysis identifies patients at increased risk and severity of IP-POC. Men, COPD, GERD patients, and smokers are particularly vulnerable to severe postoperative complications. This understanding may be useful in refining postoperative-protocols and resource-allocation more effectively in MS care.