Background

As the prevalence of obesity continues to increase, more patients will qualify for sleeve gastrectomy (SG), the most popular weight loss surgery nationwide. Geographical and hospital characteristics have been associated with disparities, including access to surgical care, postoperative morbidity, and mortality. This study explores the differences in preoperative patient characteristics and postoperative outcomes in relation to hospital characteristics among SG patients nationwide.

Methods

We analyzed the National Inpatient Sample (NIS) from 2015 to 2017. We used the patient demographics, hospital location, bed-size, teaching status, and ownership as independent variables. Outcomes of interest included hospital length of stay (LOS), total charges, mortality, and in-hospital complications. Univariate analysis included Chi-Square test for categorical and t-test for continuous variables. Multivariate analysis included logistic regression for categorical and generalized least squares regression for continuous variables. We controlled for comorbidities using the Elixhauser mortality and readmission indexes. An α-level of 0.05 was considered statistically significant.

Results

The sample was representative of 286,290 SG patients. Most patients were treated at large and urban teaching hospitals. LOS and total charges were significantly lower in small/ medium and rural/ urban non-teaching hospitals compared to large and urban teaching hospitals, respectively(p<0.001). Although in-hospital morbidity did not differ, mortality was lower in small and rural hospitals (p<0.001).

Conclusions

Our nationwide study revealed that hospital characteristics correlate to different outcomes among SG patients. Hospital size and teaching status were the variables with the strongest impact on outcomes, such as LOS and mortality.