Serious complications from bariatric surgery are fewer when done by high-volume hospitals and surgeons
The safety of bariatric surgery and uneven quality from hospital to hospital continue to concern patient advocacy groups and payers, despite trends toward declining surgery-related deaths. A new study found that the more bariatric surgeries that a hospital or surgeon perform, the lower the complication rate. Overall, 7.3 percent of bariatric surgery patients experienced perioperative complications, most of which were minor. Approximately 2.5 percent of patients had more serious complications, according to Nancy J.O. Birkmeyer, Ph.D., of the University of Michigan, and colleagues. Serious complications were highest for patients undergoing gastric bypass (3.6 percent), followed by sleeve gastrectomy (2.2 percent), and laparoscopic adjustable band procedures (0.9 percent).
Adjusted rates of serious complications were 4.1 percent, 2.7 percent, and 1.9 percent in low-, medium-, and high-volume hospitals, respectively. Serious complication rates were about twice as high (4.0 percent) for low-volume surgeons at low-volume hospitals than for high-volume surgeons at high-volume hospitals (1.9 percent). Mortality varied by the type of surgery: 0.04 percent for laparoscopic adjustable gastric band, 0 percent for sleeve gastrectomy, and 0.14 percent for gastric bypass patients. The study included 25 Michigan hospitals, 62 surgeons, and 15,275 patients who underwent bariatric procedures between 2006 and 2009. Its purposes were to assess the complication rates for three common bariatric procedures and the variability in rates of serious complications across hospitals based on procedure volume and center of excellence (COE) status.
COE accreditation typically includes minimum procedure-volume standards, availability of specific protocols and resources for managing morbidly obese patients, and submission of outcomes data to a central registry. The rates of serious complications were unrelated to COE status. This study was partly supported by the Agency for Healthcare Research and Quality (HS18050, HS18728).
See "Hospital complication rates with bariatric surgery in Michigan," by Dr. Birkmeyer, Justin B. Dimick, M.D., M.P.H., David Share, M.D., M.P.H., and others in the July 28, 2010, Journal of the American Medical Association 304(4), pp. 435-442.
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