Impact of Functional Status on 30-day Resource Utilization and Organ System Complications Following Bariatric Surgery

Study Overview
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Brief Summary
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The goal of this observational study is to assess the effect of functional status on bariatric surgical thirty-day outcomes. The main questions it aims to answer are: Is functional status associated with higher incidence of 30-day unplanned resource utilization? Is functional status associated with higher incidences of secondary adverse events? Participants will be sampled from the 2015-2019 American College of Surgeons National Surgical Quality Improvement Program

Official Title
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Impact of Functional Status on 30-day Resource Utilization and Organ System Complications Following Index Bariatric Surgery: a Cohort Study

Conditions
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Dependence, Perioperative/Postoperative Complications, Frailty

Intervention / Treatment
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* Procedure: Bariatric surgery
* Drug: General anesthetic
* Device: Indeterminate


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Current Procedural Terminology (CPT) codes: 43644, 43645, 43770, 43775, 43842, 43843, 43845, 43846, 43847 Elective, non-emergent cases General surgery surgical specialty General anesthesia anesthetic technique Exclusion Criteria: Documented concurrent or other procedures Patients admitted to the hospital for greater than one day preceding surgery Acute kidney injury (preoperative) End-stage renal disease (preoperative) Metastatic disease (preoperative) Wound infection (preoperative) Sepsis (preoperative)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Dependent functional status<br>223 patients; dependent for those documented as partially dependent or totally dependent. | Procedure: Bariatric surgery<br>* Current Procedural Terminology (CPT) codes: 43644, 43645, 43770, 43775, 43842, 43843, 43845, 43846, 43847.<br>Drug: General anesthetic<br>* Cases were required to have a documented general anesthesia anesthetic technique. Administered drugs were otherwise indeterminate under the current study design (observational study of a deidentified database).<br>Device: Indeterminate<br>* Devices were indeterminate under the current study design (observational study of a deidentified database).<br>|
| Independent functional status<br>65404 patients; independent for those documented as such. | Procedure: Bariatric surgery<br>* Current Procedural Terminology (CPT) codes: 43644, 43645, 43770, 43775, 43842, 43843, 43845, 43846, 43847.<br>Drug: General anesthetic<br>* Cases were required to have a documented general anesthesia anesthetic technique. Administered drugs were otherwise indeterminate under the current study design (observational study of a deidentified database).<br>Device: Indeterminate<br>* Devices were indeterminate under the current study design (observational study of a deidentified database).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Unplanned resource utilization (composite) | A composite binary outcome comprising unplanned readmission, return to the operating room, or prolonged (≥ 30 day) length of stay. | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Composite organ system complications | Cardiac complications included cardiac arrest and myocardial infarction. The only neurologic complication that was captured was stroke/cerebrovascular accident. Respiratory complications included reintubation, prolonged ventilatory wean, and pneumonia. Hematologic/infectious complications included superficial surgical site infection (SSI), deep incisional SSI, organ space SSI, wound dehiscence, bleeding, sepsis, septic shock, deep venous thrombosis, and pulmonary embolism. Renal complications included progressive renal insufficiency and acute kidney injury. | 30 days | 
| Mortality | Mortality | 30 days |