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Bariatric peri-operative outcomes are affected by annual procedure-specific surgeon volume

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Abstract

Background

There is limited data examining specific annual surgeon procedural volumes associated with improvement of postoperative outcomes following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Objectives

Effect of surgeon volume on procedural outcomes.

Methods

Using the SPARCS Administrative database, patients undergoing laparoscopic RYGB or SG between 2010–2014 were analyzed. Multivariable generalized linear mixed regression models were first used to analyze the influences of 3 yearly mean volumes (combined, RYGB and SG mean volumes) on each of three surgical outcomes: 30-day readmission, peri-operative complications, and extended length of stay (LOS), while accounting for patient specific variables.

Results

A total of 46,511 laparoscopic bariatric procedures were included in the study. Risk for any complication and 30-day readmissions following RYGB decreased with increasing RYGB volume up to a specific volume and stayed similar afterward (OR 0.97, 95% CI 0.96–0.98 while volume < 247.9 cases/year and OR 0.99, 95% CI 0.98–0.99 while volume < 354.1 cases/year, respectively) while risk for extended LOS decreased with increasing combined bariatric mean volume up to a specific volume and stayed similar afterward (OR 0.9, 95% CI 0.85–0.95 while volume < 62.1 cases/year). Similar patterns were found for extended LOS and complications following SG (OR 0.82, 95% CI 0.72–0.93 while SG volume < 26.3 cases/year and OR 0.94, 95% CI 0.91–0.98 while combined volume < 62.1 cases/year, respectively), while 30-day readmission following SG significantly increased when combined bariatric volume being more than 138 cases/year (OR 1.10, 95% CI 1.00–1.21 while combined volume > 138 cases/year)).

Conclusions

Bariatric procedure peri-operative outcomes are affected by procedure-specific annual surgeons’ volume.

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Acknowledgement

We acknowledge the biostatistical consultation and support provided by the Biostatistical Consulting Core at School of Medicine, Stony Brook University.

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Authors and Affiliations

  1. Minimally Invasive Surgery, Washington University School of Medicine, 660 Euclid Ave, Campus, PO Box 8109, St. Louis, MO, 63110, USA

    Maria S. Altieri

  2. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, USA

    Aurora D. Pryor, Mark A. Talamini & Konstantinos Spaniolas

  3. Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, USA

    Jie Yang

  4. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, USA

    Lizhou Nie

Authors
  1. Maria S. Altieri
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  2. Aurora D. Pryor
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  3. Jie Yang
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  4. Lizhou Nie
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  5. Mark A. Talamini
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  6. Konstantinos Spaniolas
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Corresponding author

Correspondence to Maria S. Altieri.

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Disclosures

Dr. Pryor is a speaker for Ethicon, Gore, Merck and Stryker, and Medtronic. She has research support from Baronova and Obalon. Dr. Talamini is a consultant for Stryker. Dr. Spaniolas has research support from Merck. For the remaining authors, Dr. Altieri, Dr. Yang, and Ms. Yin none are declared.

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Altieri, M.S., Pryor, A.D., Yang, J. et al. Bariatric peri-operative outcomes are affected by annual procedure-specific surgeon volume. Surg Endosc 34, 2474–2482 (2020). https://doi.org/10.1007/s00464-019-07048-7

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  • DOI: https://doi.org/10.1007/s00464-019-07048-7

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