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J Am Coll Surg. 2011 Dec;213(6):771-7. doi: 10.1016/j.jamcollsurg.2011.09.006. Epub 2011 Oct 13.

Perioperative safety and volume: outcomes relationships in bariatric surgery: a study of 32,000 patients.

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1
Medical College of Wisconsin, Department of Surgery, Milwaukee, WI 53226, USA. jgould@mcw.edu

Abstract

BACKGROUND:

Accreditation of Centers of Excellence in bariatric surgery requires a hospital volume of more than 125 procedures/year. There is no evidence-based rationale for this specific threshold. Our objective was to evaluate the contemporary perioperative safety of bariatric surgery and to characterize the relationship between volume and outcomes.

STUDY DESIGN:

We queried the Nationwide Inpatient Sample 2005-2007 for open and laparoscopic bariatric procedures, complications, and death.

RESULTS:

Thirty-two thousand five hundred and nine bariatric procedures were identified (21% open bypass [Open], 58% laparoscopic bypass [Lap], 21% laparoscopic gastric band [Band]). Inpatient overall mortality was low (total 0.12%, Open 0.3%, Lap 0.09%, Band 0.02%; p < 0.05 for all comparisons). Inpatient complications were more prevalent (total 3.9%, Open 5.9%, Lap 4%, Band 1.6%, p < 0.01 for all comparisons). For all 3 procedures, using a combined end point of mortality and major complications, a volume-outcomes relationship was evident for hospitals. This relationship appeared linear with no clear point that maximally differentiated high- and low-volume centers.

CONCLUSIONS:

Using a nationwide dataset and bariatric procedure-specific data, we have demonstrated that bariatric surgery mortality and complication rates are very low. A definite volume-outcomes relationship exists when hospital-level data are analyzed, but there is no inflection point to justify selecting a specific volume threshold to determine Centers of Excellence. Low-volume centers with extremely low complication rates can be identified and, conversely, there are high-volume centers with elevated rates of complication.

[Indexed for MEDLINE]

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