General Surgery| Volume 158, ISSUE 2, P501-507, August 2015

The relationship between duration of stay and readmissions in patients undergoing bariatric surgery


      Hospital readmissions are a quality indicator in bariatric surgery. In recent years, duration of stay after bariatric surgery has trended down greatly. We hypothesized that a shorter postoperative hospitalization does not increase the likelihood of readmission.


      The University HealthSystem Consortium (UHC) is an alliance of academic medical centers and affiliated hospitals. The UHC's clinical database contains information on inpatient stay and returns (readmissions) up to 30 days after discharge. A multicenter analysis of outcomes was performed by the use of data from the January 2009 to December 2013 for patients 18 years and older. Patients were identified by bariatric procedure International Classification of Diseases, Ninth Revision, codes and restricted by diagnosis codes for morbid obesity.


      A total of 95,294 patients met inclusion criteria. The mean patient age was 45.4 (±0.11) years, and 73,941 (77.6%) subjects were female. There were 5,423 (5.7%) readmissions within the study period. Patients with hospitalizations of 3 days and more than 3 days were twice and four times as likely to be readmitted than those with hospitalizations of one day, respectively (P < .001).


      Patients with longer postoperative hospitalizations were more likely to be readmitted after bariatric surgery. Early discharge does not appear to be associated with increased readmission rates.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kocher R.P.
        • Adashi E.Y.
        Hospital readmissions and the affordable care act: paying for coordinated quality care.
        JAMA. 2011; 306: 1794-1795
        • Elliott J.A.
        • Patel V.M.
        • Kirresh A.
        • Ashrafian H.
        • Le Roux C.W.
        • Olbers T.
        • et al.
        Fast-track laparoscopic bariatric surgery: a systematic review.
        Updates Surg. 2013; 65: 85-94
        • McCarty T.M.
        • Arnold D.T.
        • Lamont J.P.
        • Fisher T.L.
        • Kuhn J.A.
        Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass.
        Ann Surg. 2005; 242: 494-498
      1. Milliman Care Guidelines Ambulatory Care. 14th ed. Milliman Company, Seattle, WA2010
        • Morton J.M.
        • Winegar D.
        • Blackstone R.
        • Wolfe B.
        Is ambulatory laparoscopic Roux-en-Y gastric bypass associated with higher adverse events?.
        Ann Surg. 2014; 259: 286-292
        • Kaboli P.J.
        • Go J.T.
        • Hockenberry J.
        • Glasgow J.M.
        • Johnson S.R.
        • Rosenthal G.E.
        • et al.
        Associations between reduced hospital length of stay and 30-day readmission rate and mortality: 14-year experience in 129 Veterans Affairs hospitals.
        Ann Intern Med. 2012; 157: 837-845
        • Carey K.
        • Lin M.Y.
        Hospital length of stay and readmission: an early investigation.
        Med Care Res Rev. 2014; 71: 99-111
        • Carey K.
        Measuring the hospital length of stay/readmission cost trade off under a bundled payment mechanism.
        Health Econ. 2014 May 7; ([Epub ahead of print])
        • Sutton J.M.
        • Hayes A.J.
        • Wilson G.C.
        • Quillin R.C.
        • Wima K.
        • Hohmann S.
        • et al.
        Validation of the University Health System consortium administrative dataset: concordance and discordance with patient-level institutional data.
        J Surg Res. 2014; 190: 484-490
        • Saunders J.
        • Ballantyne G.H.
        • Belsley S.
        • Stephens D.J.
        • Trivedi A.
        • Ewing D.R.
        • et al.
        One-year readmission rates at a high volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass.
        Obes Surg. 2008; 18: 1233-1240
        • Baker M.T.
        • Lara M.D.
        • Larson C.J.
        • Lambert P.J.
        • Mathiason M.A.
        • Kothari S.N.
        Length of stay and impact on readmission rates after laparoscopic gastric bypass.
        Surg Obes Relat Dis. 2006; 2: 435-439
        • Hong B.
        • Stanley E.
        • Reinhardt S.
        • Panther K.
        • Garren M.J.
        • Gould J.C.
        Factors associated with readmission after laparoscopic gastric bypass surgery.
        Surg Obes Relat Dis. 2012; 8: 691-695
        • Kellogg T.A.
        • Swan T.
        • Lesli D.A.
        • Buchwald H.
        • Ikramuddin S.
        Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2009; 5: 416-424
        • Dorman R.B.
        • Miller C.J.
        • Leslie D.B.
        • Serrot F.J.
        • Slusarek B.
        • Buchwald H.
        • et al.
        Risk for hospital readmission following bariatric surgery.
        PLoS One. 2012; 7: e32506
        • Tevis S.E.
        • Kohlnhofer B.M.
        • Weber S.M.
        • Kennedy G.D.
        Post discharge complications are an important predictor of postoperative readmissions.
        Am J Surg. 2014; 208: 505-510
        • Carter J.
        • Elliott S.
        • Kaplan J.
        • Lin M.
        • Posselt A.
        • Rogers S.
        Predictors of hospital stay following laparoscopic gastric bypass: analysis of 9,593 patients from the National Surgical Quality Improvement Program.
        Surg Obes Relat Dis. 2015; 11: 288-294
        • Reynoso J.F.
        • Tiwari M.M.
        • Tsang A.W.
        • Oleynikov D.
        Does illness severity matter? A comparison of laparoscopic esophagomyotomy with fundoplication and esophageal dilation for achalasia.
        Surg Endosc. 2011; 25: 1466-1471
        • Geubbels N.
        • Bruin S.C.
        • Acherman Y.
        • van de Laar A.
        • Hoen M.B.
        • Brauw L.
        Fast track care for gastric bypass patients decreases length of stay without increasing complications in an unselected patient cohort.
        Obes Surg. 2014; 24: 390-396
        • Lemanu D.P.
        • Singh P.P.
        • Berridge K.
        • Burr M.
        • Birch C.
        • Babor R.
        • et al.
        Randomized clinical trial of enhanced recovery versus standard care after laparoscopic sleeve gastrectomy.
        Br J Surg. 2013; 100: 482-489
        • Dallal R.M.
        • Trang A.
        Analysis of perioperative outcomes, length of hospital stay, and readmission rate after gastric bypass.
        Surg Endosc. 2012; 26: 754-758
        • Brown R.E.
        • Qadan M.
        • Martin II, R.C.
        • Polk H.C.
        The evolving importance of readmission data to the practicing surgeon.
        J Am Coll Surg. 2010; 211: 558-560
        • Hyder O.
        • Dodson R.M.
        • Nathan H.
        • Schneider E.B.
        • Weiss M.J.
        • Cameron J.L.
        • et al.
        Influence of patient, physician, and hospital factors on 30-day readmission following pancreatoduodenectomy in the United States.
        JAMA Surg. 2013; 148: 1095-1102
        • Kent T.
        • Sachs T.E.
        • Callery M.P.
        • Vollmer C.M.
        Readmission after major pancreatic resection: a necessary evil?.
        J Am Coll Surg. 2011; 213: 515-523
        • Hechenbleikner E.M.
        • Makary M.A.
        • Samarov D.V.
        • Bennett J.L.
        • Gearhart S.L.
        • Efron J.E.
        • et al.
        Hospital readmission by method of data collection.
        J Am Coll Surg. 2013; 216: 1150-1158
        • Davenport D.L.
        • Holsapple C.W.
        • Conigliaro J.
        Assessing surgical quality using administrative and clinical data sets: a direct comparison of the University HealthSystem Consortium Clinical Database and the National Surgical Quality Improvement Program data set.
        Am J Med Qual. 2009; 24: 395-402