Faculty Collaboration Database

Hospital variation in perioperative complications for laparoscopic sleeve gastrectomy in Michigan. Surgery 2016 Apr;159(4):1113-20

Date

10/28/2015

Pubmed ID

26506567

Pubmed Central ID

PMC4788541

DOI

10.1016/j.surg.2015.08.044

Scopus ID

2-s2.0-84959912863 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

BACKGROUND: Laparoscopic sleeve gastrectomy has surpassed gastric bypass and laparoscopic adjustable gastric banding recently as the most common weight-loss procedure. Previously, substantial concerns existed regarding variation in perioperative safety with bariatric surgery. This study aimed to assess rates of perioperative complications for laparoscopic sleeve gastrectomy across hospitals and in relation to procedure volume within the Michigan Bariatric Surgery Collaborative.

STUDY DESIGN: We analyzed 8,693 patients who underwent laparoscopic sleeve gastrectomy from 2013 through 2014 across 40 hospitals in the Michigan Bariatric Surgery Collaborative. Mixed-effects logistic regression was used to assess hospital variation in risk- and reliability-adjusted rates of overall and serious 30-day complications and their relationship with hospital annual volume of stapling procedures (gastric bypass and sleeve gastrectomy).

RESULTS: Overall, 5.4% of patients experienced perioperative complications. Adjusted rates of overall complications varied three-fold across hospitals, ranging from 3.6% (95% confidence interval 1.9-6.8%) to 11.0% (95% confidence interval 7.7-15.5%). Serious complications occurred in just 1.2% of patients and varied minimally. In this analysis, hospital volume was not associated with overall or serious complications. The 1 hospital with significantly less overall complication rates was high-volume (≥ 125 procedures/year); however, of the 4 hospitals with significantly greater complication rates, 3 were medium-volume (50-124 procedures/year), and 1 was high-volume. The remaining hospitals were not significantly different than the cohort mean.

CONCLUSION: Serious complications among patients undergoing laparoscopic sleeve gastrectomy were relatively infrequent in this cohort of patients in the Michigan Bariatric Surgery Collaborative. Rates of overall complications varied widely across the hospitals enrolled in this statewide quality collaborative, although this variation was unrelated to volume standards required for accreditation as a comprehensive bariatric surgery center.

Author List

Pradarelli JC, Varban OA, Ghaferi AA, Weiner M, Carlin AM, Dimick JB

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

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

Adult
Aged
Female
Gastrectomy
Healthcare Disparities
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Laparoscopy
Logistic Models
Male
Michigan
Middle Aged
Postoperative Complications