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Evaluating outcomes among surgeons who changed their technique for gastric bypass: a state-wide analysis from 2011 to 2021

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Abstract

Introduction

Technical variation exists when performing the gastrojejunostomy during Roux-en-Y gastric bypass (RYGB). However, it is unclear whether changing technique results in improved outcomes or patient harm.

Methods

Surgeons participating in a state-wide bariatric surgery quality collaborative who completed a survey on how they perform a typical RYGB in 2011 and again in 2021 were included in the analysis (n = 31). Risk-adjusted 30-day complication rates and case characteristics for cases in 2011 were compared to those in 2021 among surgeons who changed their gastrojejunostomy technique from end-to-end anastomosis (EEA) to either a linear staple or handsewn anastomosis (LSA/HSA). In addition, case characteristics and outcomes among surgeons who maintained an EEA technique throughout the study period were assessed.

Results

A total of 15 surgeons (48.3%) changed their technique from EEA to LSA/HSA while 7 surgeons (22.3%) did not. Nine surgeons did LSA or HSA the entire period and therefore were not included. Surgeons who changed their technique had significantly lower rates of surgical complications in 2021 when compared to 2011 (1.9% vs 5.1%, p = 0.0015), including lower rates of wound complications (0.5% vs 2.1%, p = 0.0030) and stricture (0.1% vs 0.5%, p = 0.0533). Likewise, surgeons who did not change their EEA technique, also experienced a decrease in surgical complications (1.8% vs 5.8%, p < 0.0001), wound complications (0.7% vs 2.1%, p < 0.0001) and strictures (0.2% vs 1.2%, p = 0.0006). Surgeons who changed their technique had a significantly higher mean annual robotic bariatric volume in 2021 (30.0 cases vs 4.9 cases, p < 0.0001) when compared to those who did not.

Conclusions

Surgeons who changed their gastrojejunostomy technique from circular stapled to handsewn demonstrated greater utilization of the robotic platform than those who did not and experienced a similar decrease in adverse events during the study period, despite altering their technique. Surgeons who chose to modify their operative technique may be more likely to adopt newer technologies.

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Abbreviations

EEA:

End-to-end anastomosis

GJ:

Gastrojejunostomy

HAS:

Hand sewing anastomosis

LSA:

Linear stapler anastomosis

MBSC:

Michigan Bariatric Surgical Collaborative

RYGB:

Roux-en-Y gastric bypass

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Funding

Support for the Michigan Bariatric Surgery Collaborative (MBSC) is provided by Blue Cross and Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program.

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Authors and Affiliations

  1. Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA

    Ahmad M. Hider, Jonathan Finks & Anne P. Ehlers

  2. Department of Surgery, Henry Ford Health, Detroit, MI, USA

    Hollis Johanson, Arthur M. Carlin & Oliver A. Varban

  3. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA

    Aaron J. Bonham

  4. Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA

    Amir A. Ghaferi, Jonathan Finks, Anne P. Ehlers, Arthur M. Carlin & Oliver A. Varban

  5. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Amir A. Ghaferi

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  1. Ahmad M. Hider
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  2. Hollis Johanson
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Correspondence to Ahmad M. Hider.

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Disclosures

Drs. Jonathan Finks and Amir Ghaferi receive salary support from Blue Cross Blue Shield of Michigan for leadership and participation in the Michigan Bariatric Surgery Collaborative. Drs. Arthur Carlin and Oliver Varban receive an honorarium for their leadership and participation in the Michigan Bariatric Surgery Collaborative. Dr. Anne Ehlers receives unrelated funding from SAGES and the Association for Academic Surgery. Although Blue Cross Blue Shield of Michigan and the Michigan Bariatric Surgery Collaborative (MBSC) work collaboratively, the opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of BCBSM or any of its employees. Ahmad M. Hider, Hollis Johanson, Aaron J. Bonham, Amir A. Ghaferi, Jonathan Finks, Anne P. Ehlers, Arthur M. Carlin and Oliver A. Varban have no conflicts of interest or financial ties to disclose.

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Hider, A.M., Johanson, H., Bonham, A.J. et al. Evaluating outcomes among surgeons who changed their technique for gastric bypass: a state-wide analysis from 2011 to 2021. Surg Endosc 37, 8464–8472 (2023). https://doi.org/10.1007/s00464-023-10434-x

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