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The effect of surrogate procedure volume on bariatric surgery outcomes: do common laparoscopic general surgery procedures matter?

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Abstract

Background

A growing body of evidence shows that experience and acquired skills from surrogate surgical procedures may be transferrable to a specific index operation. It is unclear whether this applies to bariatric surgery. This study aims to determine whether there is a surrogate volume effect of common laparoscopic general surgery procedures on all-cause bariatric surgical morbidity.

Methods

This was a population-based study of all patients aged ≥ 18 who received a bariatric procedure in Ontario from 2008 to 2015. The main outcome of interest was all-cause morbidity during the index admission. All-cause morbidity included any documented complication which extended length of stay by 24 h or required reoperation. Bariatric cases included laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. Non-bariatric cases included three common laparoscopic general surgery procedures.

Results

13,836 bariatric procedures were performed by 29 surgeons at nine centers of excellence. A reduction in all-cause morbidity was seen when bariatric surgeons exceeded 75 cases annually (OR 0.82, 95% CI 0.69–0.98, P = 0.023), with further reduction in increasing bariatric volume. However, the volume of non-bariatric surgeries did not significantly affect bariatric all-cause morbidity rates amongst bariatric surgeons, even when exceeding 100 cases (OR 0.84, 95% CI 0.61–1.12, P = 0.222).

Conclusions

The present study suggests that experience and skills acquired in performing non-bariatric laparoscopic general surgery does not appear to affect all-cause morbidity in bariatric surgery. Therefore, only a surgeon’s bariatric procedure volume should considered be a quality marker for outcomes after bariatric surgery.

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Authors and Affiliations

  1. Division of General Surgery, University of Toronto, Toronto, ON, Canada

    Kyle D. Hunt

  2. Division of General Surgery, McMaster University, Hamilton, ON, Canada

    Aristithes G. Doumouras, Yung Lee, Scott Gmora, Mehran Anvari & Dennis Hong

  3. Centre for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada

    Aristithes G. Doumouras, Yung Lee, Scott Gmora, Mehran Anvari & Dennis Hong

  4. Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Dennis Hong

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  1. Kyle D. Hunt
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  2. Aristithes G. Doumouras
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Correspondence to Dennis Hong.

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Kyle D. Hunt, Aristithes G. Doumouras, Yung Lee, Scott Gmora, Mehran Anvari, and Dennis Hong have no conflicts of interest or financial ties to disclose.

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Hunt, K.D., Doumouras, A.G., Lee, Y. et al. The effect of surrogate procedure volume on bariatric surgery outcomes: do common laparoscopic general surgery procedures matter?. Surg Endosc 34, 1278–1284 (2020). https://doi.org/10.1007/s00464-019-06897-6

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