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Surgeon variation in severity of reflux symptoms after sleeve gastrectomy

  • 2019 SAGES Oral
  • Published:
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Abstract

Background

Prior studies have demonstrated an increase in gastroesophageal reflux after laparoscopic sleeve gastrectomy (LSG). However, it is unknown whether symptom severity varies or if outcomes are surgeon-specific.

Methods

A validated reflux symptom survey was obtained at baseline and at 1 year after primary LSG on 7358 patients participating in a state-wide quality improvement collaborative between 2013 and 2018. Patients with worsening symptoms after surgery were divided into terciles based on the degree of increase in survey score (0 = no symptoms, 50 = max symptoms). Surgeon-level data was obtained on 52 bariatric surgeons performing at least 25 LSG cases/year during the study period. Surgeon characteristics, operative experience, and risk-adjusted 30-day complication rates were compared between surgeons in the highest tercile for moderate worsening of symptoms vs those in the lowest.

Results

A total of 2294 (31.2%) patients had worsening symptoms of reflux after sleeve gastrectomy. Overall mean increase in severity score was 6.11 (range 1 to 48) and patients with minimal, mild, and moderate symptoms had a mean increase of 1.4, 4.2, and 13.8, respectively. There were no significant differences in surgeon-specific characteristics when comparing surgeons in the highest tercile for moderate worsening of symptoms (44.7% of patients) vs those in the lowest tercile (18.7% of patients). In addition, there were no significant differences in risk-adjusted rates of overall complications (3.70% vs. 4.33%, p = 0.686), endoscopic dilations (2.83% vs. 1.91%, p = 0.417), or concurrent hiatal hernia repair (34.3% vs. 27.0%, p = 0.415) between surgeons in the highest and lowest terciles.

Conclusions

We found that 1/3 of patients had worsening symptoms of reflux after LSG and that severity of symptoms varied. Surgeons with the highest rates of worsening reflux had similar operative experience and complication rates than those with the lowest. Further assessment of operative technique and skill may be informative.

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Funding

Blue Cross Blue Shield of Michigan/Blue Care Network—the funding source had no involvement in collection, analysis and interpretation of data; writing of the report; or in the decision to submit the article for publication

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Authors and Affiliations

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

    Oliver A. Varban, Dana A. Telem, Nabeel R. Obeid, Jonathan F. Finks, Amir A. Ghaferi & Justin B. Dimick

  2. Center for Healthcare Outcomes and Policy, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Bldg. 16, Ann Arbor, MI, 48109, USA

    Jyothi R. Thumma, Dana A. Telem, Jonathan F. Finks, Amir A. Ghaferi & Justin B. Dimick

  3. Michigan Medicine, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA

    Oliver A. Varban

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  1. Oliver A. Varban
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  2. Jyothi R. Thumma
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  3. Dana A. Telem
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Correspondence to Oliver A. Varban.

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Disclosures

Oliver A. Varban—Receives salary support from Blue Cross Blue Shield of Michigan/Blue Care Network for leadership and participation in quality improvement initiatives through the Michigan Bariatric Surgery Collaborative. Dana A. Telem—Reports grants from NIDDK, AHRQ and Medronic. Jonathan F. Finks—Receives salary support from Blue Cross Blue Shield of Michigan/Blue Care Network for leadership and participation in quality improvement initiatives through the Michigan Bariatric Surgery Collaborative. Amir A. Ghaferi—Reports grants from Blue Cross Blue Shield of Michigan/Blue Care Network during the conduct of the study. Justin B. Dimick—Reports other from ArborMetrix, personal fees from Northwestern University, Beth Israel Deaconess Medical Center, University of Rochester Medical Center, outside the submitted work. Jyothi R. Thumma and Nabeel R. Obeid have no conflicts of interest or financial ties to disclose.

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Varban, O.A., Thumma, J.R., Telem, D.A. et al. Surgeon variation in severity of reflux symptoms after sleeve gastrectomy. Surg Endosc 34, 1769–1775 (2020). https://doi.org/10.1007/s00464-019-06928-2

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  • DOI: https://doi.org/10.1007/s00464-019-06928-2

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