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Background

Studies have consistently shown RA-MBS to have longer operative times and higher readmission rates compared with laparoscopic (Lap) MBS. The aim of our study was to identify platform-based predictors of readmission after MBS.

Methods

2015-2021 MBSAQIP Participant Use files were used to identify index Lap or RA-MBS. Propensity scores were used to match Lap or RA cases (1:1) from 847,833 Lap and 121,295 RA. Multivariate logistic regression models and chi square were used to evaluate predictors of 30-day readmission (overall and within surgical approach).

Results

Propensity matching of 242,590 patients (121,295 Lap and RA), found mean operative time (OpT) was longer (RA=108.5 vs. Lap=81.1) and readmissions were higher in RA (3.8% vs. 3.2%, OR=1.19, 95% CI [1.14-1.24]). Multiple regression analysis confirmed a significant association of both RA-MBS and OpT with readmission, (RA OR=1.08, 95% CI[1.03, 1.13] and each 15-minutes of OpT (OR=1.04, 95% CI[1.03-1.05]). Lap cases were 4X more likely to be completed under 50 minutes than RA. History of PE was the only preoperative factor predictive of readmission for RA that was not predictive for Lap (OR=1.57, 95%CI=[1.29-1.91]). Adverse occurrences more common in RA versus Lap-MBS included organ space infection (0.31% vs. 0.25% p=0.0021), pneumonia (0.21% vs. 0.15% p=0.0025) and unplanned intubation (0.13% vs. 0.1% p=0.007).

Conclusions

A review of all MBSAQIP PUF years, found that longer operative time was independently and significantly associated with greater readmission after MBS. The significantly longer operative times for patients undergoing RA-MBS are the most significant driver of excess readmissions.