Abstract
Objectives
The aim of this study was to determine the efficacy of coaching on outcome in low volume centers of excellence and to evaluate the influence of mentorship programs on the center development.
Background
The number of bariatric procedures has increased steadily in the last years. Providing nationwide bariatric care on a high professional level needs structures to train and guide upcoming centers and ensure high quality in patient care.
Methods
A prospective multicentered, observational study including laparoscopic sleeve gastrectomies (SG) and Roux-en-Y gastric bypass (RYGB) procedures was performed. Twelve emerging bariatric centers were coached by five experienced bariatric centers. Surgeons of the mentor centers gave guidance on pre- and postsurgical management of their patients including complications and proctored the first interventions. The results were compared regarding operative outcomes, percentage of excess weight loss, complications, and resolution of comorbidities.
Results
A total of 214 of 293 patients (73.0%) completed the study. The most frequently reported complications were wound infection (4.4%), disorder of emptying stomach/new reflux (2.4%), anastomotic leaks, intra-abdominal secondary hemorrhage, and dumping syndrome (2.0% each). The mortality rate was zero. We found no difference in overall complication rates or resolution of obesity-related comorbidities when comparing experienced surgeons with less experienced surgeons.
Conclusions
Our results suggest that under the conditions of the practices of this study, coaching and mentoring were associated with comparable outcomes both in experienced and emerging centers. In addition, mentorship programs ensure equal outcome quality in terms of improvement of obesity-associated comorbidities.
Trial Registration
NCT Number: NCT01754194.
Similar content being viewed by others
References
Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766–81.
Wilson MZ, Dillon PW, Hollenbeak CS, et al. How do risk factors for mortality and overall complication rates following laparoscopic and open colectomy differ between inpatient and post-discharge phases of care? A retrospective cohort study from NSQIP. Surg Endosc. 2014;28(12):3392–400.
Ditillo M, Pandit V, Rhee P, et al. Morbid obesity predisposes trauma patients to worse outcomes: a National Trauma Data Bank analysis. J Trauma Acute Care Surg. 2014;76(1):176–9.
Wigfield CH, Lindsey JD, Muñoz A, et al. Is extreme obesity a risk factor for cardiac surgery? An analysis of patients with a BMI > or = 40. Eur J Cardiothorac Surg. 2006;29(4):434–40.
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med. 2014;370(21):2002–13.
Sjostrom L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.
Stroh C, Weiner R, Benedix F, et al. Bariatric and metabolic surgery in Germany 2012 - Results of the quality assurance study on surgery for obesity (data of the German bariatric surgery registry). Zentralbl Chir. 2014;139(2):e1–5.
Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4(4):353–7.
Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008;22(12):2554–63.
Zellmer JD, Mathiason MA, Kallies KJ, et al. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg. 2014;208(6):903–10. discussion 909-10
Shikora SA, Kim JJ, Tarnoff ME, et al. Laparoscopic Roux-en-Y gastric bypass: results and learning curve of a high-volume academic program. Arch Surg. 2005;140(4):362–7.
Breaux JA, Kennedy CI, Richardson WS. Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21(6):985–8.
Nguyen NT, Paya M, Stevens CM, et al. The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg. 2004;240(4):586–93. discussion 593-4
Flum DR, Salem L, Elrod JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294(15):1903–8.
Runkel N, Colombo-Benkmann M, Hüttl TP, et al. Bariatric surgery. Dtsch Arztebl Int. 2011;108(20):341–6.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
Swanstrom LL, Park A, Arregui M, et al. Bringing order to the chaos: developing a matching process for minimally invasive and gastrointestinal postgraduate fellowships. Ann Surg. 2006;243(4):431–5.
Lord JL, Cottam DR, Dallal RM, et al. The impact of laparoscopic bariatric workshops on the practice patterns of surgeons. Surg Endosc. 2006;20(6):929–33.
Abu-Hilal M, vanden Bossche M, Bailey IS, et al. A two-consultant approach is a safe and efficient strategy to adopt during the learning curve for laparoscopic Roux-en-Y gastric bypass: our results in the first 100 procedures. Obes Surg. 2007;17(6):742–6.
Ballantyne GH, Ewing D, Capella RF, et al. The learning curve measured by operating times for laparoscopic and open gastric bypass: roles of surgeon’s experience, institutional experience, body mass index and fellowship training. Obes Surg. 2005;15(2):172–82.
Sargeant J, Bruce D, Campbell CM. Practicing physicians’ needs for assessment and feedback as part of professional development. J Contin Educ Health Prof. 2013;33(Suppl 1):S54–62.
Regehr G, Mylopoulos M. Maintaining competence in the field: learning about practice, through practice, in practice. J Contin Educ Health Prof. 2008;28(Suppl 1):S19–23.
Mutabdzic D, Mylopoulos M, Murnaghan ML, et al. Coaching surgeons: is culture limiting our ability to improve? Ann Surg. 2015;262(2):213–6.
Stroh C, Birk D, Flade-Kuthe R, et al. Results of sleeve gastrectomy-data from a nationwide survey on bariatric surgery in Germany. Obes Surg. 2009;19(5):632–40.
Suter M, Giusti V, Héraief E, et al. Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc. 2003;17(4):603–9.
Oliak D, Ballantyne GH, Weber P, et al. Laparoscopic Roux-en-Y gastric bypass: defining the learning curve. Surg Endosc. 2003;17(3):405–8.
Muilwijk J, van den Hof S, Wille JC. Associations between surgical site infection risk and hospital operation volume and surgeon operation volume among hospitals in the Dutch nosocomial infection surveillance network. Infect Control Hosp Epidemiol. 2007;28(5):557–63.
Kalarchian MA, Marcus MD, Courcoulas AP, et al. Self-report of gastrointestinal side effects after bariatric surgery. Surg Obes Relat Dis. 2014;10(6):1202–7.
Li J, Lai D, Wu D. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy to treat morbid obesity-related comorbidities: a systematic review and meta-analysis. Obes Surg. 2016;26(2):429–42.
Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24(3):437–55.
Benedix F, Kusibab M, Adolf D, et al. Roux-Y gastric bypass for morbid obesity in adolescents: is it as safe and effective as in obese adults? Zentralbl Chir. 2017;143:425–32. https://doi.org/10.1055/s-0043-104217.
Acknowledgments
The authors like to thank the participating hospitals for their commitment: Krankenhaus Bad Cannstatt, Stuttgart, Germany; Bundeswehr Krankenhaus Berlin, Berlin, Germany; Franziskus Hospital Bielefeld, Bielefeld, Germany; Klinikum Bremerhaven-Reinkenheide, Bremerhaven, Germany; Amperklinikum Dachau, Dachau, Germany; Kreiskrankenhaus Emmendingen, Emmendingen, Germany; Universitätsklinik Hamburg Eppendorf, Hamburg, Germany; Ev. Krankenhaus Herne, Herne, Germany; Klinikum Itzehoe, Itzehoe, Germany; Marienkrankenhaus Kassel, Kassel, Germany; Krankenhaus Luebbecke, Luebbecke, Germany; Sana Klinikum Lübeck, Lübeck, Germany; Diakoniekrankenhaus Mannheim, Mannheim, Germany; Krankenhaus Hetzelstift Neustadt/Weinstraße, Neustadt, Germany; Thüringen-Kliniken “Georgius Agricola”, Saalfeld, Germany; Schwarzwald Baar Klinikum Villingen, Villingen-Schwenningen, Germany; and Krankenhaus Winsen, Winsen (Luhe), Germany.
Funding
Medtronic MITG supported the study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The study protocol, all study protocol amendments, written study patient information, informed consent form (ICF) and any other appropriate study-related information were reviewed and approved by an Independent Ethics Committee (IEC) or Institutional Review Board (IRB) at each study site. The study was also conducted with scientific purpose, value, and rigor and followed generally accepted research practices such as the International Conference on Harmonization Good Clinical Practice (ICH GCP) guidelines. Compliance with these requirements also constitutes conformity with the ethical principles of the Declaration of Helsinki
Conflict of interest
The authors have no financial support or commercial associations that may be a conflict of interest in relation to this article.
Rights and permissions
About this article
Cite this article
Wolter, S., Duprée, A., ElGammal, A. et al. Mentorship Programs in Bariatric Surgery Reduce Perioperative Complication Rate at Equal Short-Term Outcome—Results from the OPTIMIZE Trial. OBES SURG 29, 127–136 (2019). https://doi.org/10.1007/s11695-018-3495-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-018-3495-2