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. 2020 Jun;34(6):2474-2482.
doi: 10.1007/s00464-019-07048-7. Epub 2019 Aug 6.

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

Maria S Altieri  1 , Aurora D Pryor  2 , Jie Yang  3 , Lizhou Nie  4 , Mark A Talamini  2 , Konstantinos Spaniolas  2
Affiliations

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

Maria S Altieri et al. Surg Endosc. 2020 Jun.

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.

Keywords: Bariatrics; Surgeon volume.

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