Up to a third of LRYGB patient readmitted two years after surgery
A systematic review has reported that readmission after laparoscopic Roux-en-Y gastric bypass (LRYGB) was 29% at two years and 23.9% at 4.2 years of follow-up, with abdominal pain the most common reason for Emergency Department (ED) visits and readmissions. The findings were featured in the paper, 'Long-term Emergency Department Visits and Readmissions After Laparoscopic Roux-en-Y Gastric Bypass: a Systematic Review', published in Obesity Surgery,
The researchers from The Netherlands noted that although there is considerable evidence on the short-term outcomes after LRYGB (published short-term outcomes after LRYGB vary from 5.1–6.1% for readmissions and 11.3% ED visits in the first 30 days after surgery), there is little in the literature on the long-term outcomes, specifically on post-operative ED visits and readmissions. Therefore, they undertook a systematic review on the incidence, indications and risk factors of ED visits and readmissions beyond 30 days after LRYGB.
The primary outcome for their systematic review was the number of ED visits and readmissions >30 days after LRYGB, and the secondary outcome measures are indications and risk factors for ED visits and readmissions. In total, 20 articles - six studies reported on ED visits (n=2,818) and 19 on readmissions (n=276,543). The majority of patients were female (63.0–90.9%), mean BMI ranged from 41.3–58.4 kg/m2 and mean age from 38.2 to 48.7 years.
The rate of patients with an ED visit within 90 days after surgery ranged from 3.9 to 32.6%. ED visits at one, two and three years occurred in 25.6%, 30.0% and 31.1% of patients. Readmissions within 90 days and at one-year follow-up ranged from 4.1 to 20.5% and 4.75 to 16.6%, respectively. Readmission was 29% at two years and 23.9% at 4.2 years of follow-up. The most common reason for ED visits and readmissions was abdominal pain.
The main indications for ED visits at 90 days were nausea and vomiting, dehydration, abdominal pain (cholelithiasis not included) and wound issues. At one, two and three years, the main reasons were abdominal pain (45.2%, 47.4%, 47.6%), nausea and vomiting (18.4%, 17.9%, 18.4%), abdominal pain and vomiting combined (16.7%, 15.6%, 15.1%), and other complaints (19.7%, 19.2%, 19.0%).
“We can conclude that the majority of all ED visits and readmissions will take place longer than 30 days after surgery. This demonstrates that ED visits and readmissions, in the first 30 days after surgery, do not adequately reproduce the magnitude of postoperative problems faced by patients after LRYGB,” the authors write. “…Understanding the long-term problems after bariatric surgery is crucial for optimising the choice for a specific procedure and long-term post-bariatric care. Insight into ED visits and readmissions could provide more information about the impact and course of abdominal complaints over time after LRYGB.”
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