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Observational Study
. 2023 Aug;27(8):1578-1586.
doi: 10.1007/s11605-023-05690-0. Epub 2023 May 25.

Textbook Outcome in Bariatric Surgery: Evolution During 15 Years in a Referral Center

Silvia Carbonell-Morote  1   2 , Sergio Ortiz-Sebastián  3   4 , José Luis Estrada-Caballero  3   4 , Ester Gracia-Alegria  3   4 , Emilio Ruiz de la Cuesta Tapia  3   4 , Celia Villodre  3   4   5 , Carlos Felipe Campo-Betancourth  3 , Juan Jesus Rubio-García  3   4 , David Velilla-Vico  3   4 , José Manuel Ramia  3   4   5
Affiliations
Observational Study

Textbook Outcome in Bariatric Surgery: Evolution During 15 Years in a Referral Center

Silvia Carbonell-Morote et al. J Gastrointest Surg. 2023 Aug.

Abstract

Background: Textbook outcome (TO) is a multidimensional measure used to assess the quality of care. It is the "ideal" surgical result, based on a series of established indicators. In the field of bariatric surgery (BS), only one publication on TO is available.

Objectives: To determine TO in our BS unit and identify the factors linked to TO.

Setting: University public hospital in Alicante (Spain).

Methods: Retrospective observational study of all primary BS was performed. TO for BS was defined in relation to the following features: no major postoperative complications (Clavien-Dindo >II), hospital stay <75th percentile, and no mortality or readmissions within 30 days of surgery. Comparative analysis of the characteristics of the TO and non-TO groups was performed, as well as univariate and multivariate logistic regressions, to identify the independent factors associated with obtaining TO.

Results: In 970 patients, TO was achieved in 71.5%. The hospital stay was the one that most affected achievement of TO. Analysis according to the type of procedure (sleeve gastrectomy and gastric bypass) did not reveal any differences between both procedures in terms of obtaining TO (71.5 vs 71.26%). Logistic regression identified smoking, heart disease, operative time, and upper gastrointestinal bleeding as independent factors associated with obtaining TO (p<0.05). Analysis of the annual evolution of TO reveals a progressive increase in its achievement (7.7-86.4%).

Conclusion: In our series, TO was obtained in 71.5% of patients. The standardization of the technique and the experience gained over the years has improved our TO results.

Keywords: Benchmark; Obesity surgery; Roux-en-Y gastric bypass; Sleeve gastrectomy; Surgical quality; Textbook outcome.

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References

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