Context The use of Roux-en-Y gastric bypass (RYGB) has been reported to be effective
in the treatment of obesity and its related comorbidities. Utilization of
inpatient services after RYGB is less well understood.
Objective To determine the rates and indications for inpatient hospital use before
and after RYGB.
Design, Setting, and Participants Retrospective study of Californians receiving RYGB in California hospitals
from 1995 to 2004.
Main Outcome Measure Hospitalization in the 1 to 3 years after RYGB.
Results In California from 1995 to 2004, 60 077 patients underwent RYGB—11 659
in 2004 alone. The rate of hospitalization in the year following RYGB was
more than double the rate in the year preceding RYGB (19.3% vs 7.9%, P<.001). Furthermore, in the subset of patients (n = 24 678)
with full 3-year follow-up, a mean of 8.4% were admitted a year before RYGB
while 20.2% were readmitted in the year after RYGB, 18.4% in the second year
after RYGB, and 14.9% in the third year after RYGB. The most common reasons
for admission prior to RYGB were obesity-related problems (eg, osteoarthritis,
lower extremity cellulitis), and elective operation (eg, hysterectomy), while
the most common reasons for admission after RYGB were complications often
thought to be procedure related, such as ventral hernia repair and gastric
revision. In multivariate logistic regression models predicting 1-year readmission
after RYGB, increasing Charlson Comorbidity Index score, and hospitalization
in the 3-year period prior to RYGB were significantly associated with readmission
within a year.
Conclusions Increases in hospital use after surgery appear to be related to RYGB.
Payers, clinicians, and patients must consider the not-inconsequential rate
of rehospitalization after this type of surgery.