Faculty Collaboration Database

Perioperative safety and volume: outcomes relationships in bariatric surgery: a study of 32,000 patients. J Am Coll Surg 2011 Dec;213(6):771-7

Date

10/15/2011

Pubmed ID

21996483

DOI

10.1016/j.jamcollsurg.2011.09.006

Scopus ID

2-s2.0-81855194026 (requires institutional sign-in at Scopus site)   27 Citations

Abstract

BACKGROUND: Accreditation of Centers of Excellence in bariatric surgery requires a hospital volume of more than 125 procedures/year. There is no evidence-based rationale for this specific threshold. Our objective was to evaluate the contemporary perioperative safety of bariatric surgery and to characterize the relationship between volume and outcomes.

STUDY DESIGN: We queried the Nationwide Inpatient Sample 2005-2007 for open and laparoscopic bariatric procedures, complications, and death.

RESULTS: Thirty-two thousand five hundred and nine bariatric procedures were identified (21% open bypass [Open], 58% laparoscopic bypass [Lap], 21% laparoscopic gastric band [Band]). Inpatient overall mortality was low (total 0.12%, Open 0.3%, Lap 0.09%, Band 0.02%; p < 0.05 for all comparisons). Inpatient complications were more prevalent (total 3.9%, Open 5.9%, Lap 4%, Band 1.6%, p < 0.01 for all comparisons). For all 3 procedures, using a combined end point of mortality and major complications, a volume-outcomes relationship was evident for hospitals. This relationship appeared linear with no clear point that maximally differentiated high- and low-volume centers.

CONCLUSIONS: Using a nationwide dataset and bariatric procedure-specific data, we have demonstrated that bariatric surgery mortality and complication rates are very low. A definite volume-outcomes relationship exists when hospital-level data are analyzed, but there is no inflection point to justify selecting a specific volume threshold to determine Centers of Excellence. Low-volume centers with extremely low complication rates can be identified and, conversely, there are high-volume centers with elevated rates of complication.

Author List

Gould JC, Kent KC, Wan Y, Rajamanickam V, Leverson G, Campos GM

Author

Jon Gould MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Bariatric Surgery
Cross-Sectional Studies
Female
Hospitalization
Humans
Laparoscopy
Male
Obesity, Morbid
Treatment Outcome
United States