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Association of revisions or conversions after sleeve gastrectomy with annual bariatric center procedural volume in the state of New York

  • 2019 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Although bariatric center procedural volume has been associated with early perioperative safety, data on the effect of such volume and long-term outcomes after sleeve gastrectomy (SG) are limited. This study aims to examine the relationship between annual bariatric center SG volume and the incidence of revisions or conversions (RC) after SG.

Methods

The New York Statewide Planning and Research Cooperative System database was used to identify all patients who underwent SG between 2006 and 2012. Subsequent RC events were captured up to 2016. Bariatric centers having annual SG volume less than 45, between 45 and 65, and greater than 65 were defined as low (LV), medium (MV), and high volume (HV), respectively. Multivariable Cox proportional hazard regression analysis was performed to compare the risk of having RC among centers with different yearly sleeve volumes.

Results

We identified 8389 patients who underwent SG. The overall estimated cumulative incidence of RC was 0.5% (95% CI 0.3–0.6%) at 1 year, 6.2% (95% CI 5.4–7.0%) at 5 years, and 15.3% (95% CI 12.6–18.0%) at 8 years after SG. The estimated cumulative incidence of RC for LV, MV, and HV at 8 years after SG was 16.7% (95% CI 11.1–22.3%), 15.5% (95% CI 11.2–19.8%), and 13.7% (95% CI 9.4–17.9%), respectively. HV centers have lower risk of RC compared to LV (hazard ratio 0.65; 95% CI 0.48–0.88) and MV (hazard ratio 0.75; 95% CI 0.57–0.98). LV and MV centers have comparable risk of RC (hazard ratio 1.15; 95% CI 0.87–1.51). Patients having the initial SG performed in LV were the least likely to have RC in the same institution (46.1% of LV, 13.2% of MV and 22.3% of HV; p < 0.0001).

Conclusion

Patients undergoing SG at LV centers experience the highest risk of subsequent RC. This effect persists after adjusting for patient-level factors. These data underline the relationship between volume threshold and long-term effect.

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Acknowledgements

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

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Authors and Affiliations

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

    Stella T. Tsui, Mark Talamini, Aurora D. Pryor & Konstantinos Spaniolas

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

    Jie Yang

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

    Lizhou Nie

  4. Section of Minimally Invasive Surgery, Washington University Medical Center, St. Louis, MO, USA

    Maria S. Altieri

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  1. Stella T. Tsui
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Correspondence to Stella T. Tsui.

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Disclosures

No industry or other external funding was used for this research. Dr. Spaniolas receives research grant from Merck and is on the Advisory Board for Mallickrodt. Dr. Pryor receives honoraria for speaking for Ethicon, Medtronic, Stryker, and Gore and is a consultant for Merck, Obalon, and Baronova. Ms. Tsui, Dr. Yang, Mr. Nie, Dr. Altieri, and Dr. Talamini have no conflicts of interest or financial ties to disclose.

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Tsui, S.T., Yang, J., Nie, L. et al. Association of revisions or conversions after sleeve gastrectomy with annual bariatric center procedural volume in the state of New York. Surg Endosc 34, 3110–3117 (2020). https://doi.org/10.1007/s00464-019-07068-3

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  • DOI: https://doi.org/10.1007/s00464-019-07068-3

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