PMID- 21487887
OWN - NLM
STAT- MEDLINE
DCOM- 20111207
LR  - 20220408
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 25
IP  - 8
DP  - 2011 Aug
TI  - Determinants of resource utilization and outcomes in laparoscopic Roux-en-Y 
      gastric bypass: a multicenter analysis of 14,251 patients.
PG  - 2613-25
LID - 10.1007/s00464-011-1612-6 [doi]
AB  - 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.
FAU - Gupta, Prateek K
AU  - Gupta PK
AD  - Department of Surgery, Creighton University Medical Center, Omaha, NE 68131, USA.
FAU - Miller, Weldon J
AU  - Miller WJ
FAU - Sainath, Jyothsna
AU  - Sainath J
FAU - Forse, R Armour
AU  - Forse RA
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20110413
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
SB  - IM
MH  - Adult
MH  - Female
MH  - Gastric Bypass/*methods
MH  - Health Resources/*statistics & numerical data
MH  - Humans
MH  - *Laparoscopy
MH  - Male
MH  - Multivariate Analysis
MH  - Treatment Outcome
EDAT- 2011/04/14 06:00
MHDA- 2011/12/13 00:00
CRDT- 2011/04/14 06:00
PHST- 2010/04/25 00:00 [received]
PHST- 2011/01/29 00:00 [accepted]
PHST- 2011/04/14 06:00 [entrez]
PHST- 2011/04/14 06:00 [pubmed]
PHST- 2011/12/13 00:00 [medline]
AID - 10.1007/s00464-011-1612-6 [doi]
PST - ppublish
SO  - Surg Endosc. 2011 Aug;25(8):2613-25. doi: 10.1007/s00464-011-1612-6. Epub 2011 
      Apr 13.