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Bariatric surgery outcomes better at high-volume hospitals

Mortality and morbidity from bariatric surgery are less common at hospitals with high case volumes, according to data presented at the Society of American Gastrointestinal and Endoscopic Surgeons Annual Meeting in Baltimore.

Researchers evaluated data from patients who underwent elective bariatric surgery between 2006 and 2010 at low-volume (less than 50 laparoscopic stapling procedures performed annually; n=41,547 cases) (LV) or high-volume (more than 50 stapling procedures annually; n=236,219 cases) (HV) facilities.

Overall morbidity was significantly higher for LV hospitals compared with HV (6.72% of cases vs. 5.62%), as was the rate of in-hospital mortality (0.17% vs. 0.07%). Patients treated in LV facilities also incurred significantly higher charges than those treated at HV facilities (mean charge $43,714 ± $25,926 vs. $37,694 ± $28,227; P<.05 for all). Multivariate analysis indicated that patients who underwent gastric bypass or sleeve gastrectomy at an LV hospital were at a 2.5-fold greater risk for mortality (95% CI, 1.3-4.8) and 1.2 times more likely to experience serious morbidity (95% CI, 1.1-1.4) than those who underwent similar procedures at HV hospitals.

Investigators performed further analysis among HV facilities to determine the impact of accreditation as a center of excellence (COE), according to the current ACS/ASMBS definition as a center performing more than 125 bariatric surgeries of any type annually (n=216,000 COE and n=20,219 non-COE facilities). While in-hospital mortality was significantly higher among non-COE hospitals (0.06% of cases vs. 0.22%; OR=3.51; 95% CI, 1.49-8.33), the rate of serious complications was significantly lower (5.7% vs. 4.8% at non-COE facilities; OR=0.84; 95% CI, 0.71-0.98).

Researcher Ninh T. Nguyen, MD, chief of the division of gastrointestinal surgery at University of California, Irvine, attributed the difference in mortality rates between accredited vs. nonaccredited centers to a greater number of patients who developed complications at non-COE facilities and eventually died from their complications.

“There are systems in place at COE to prevent deaths arising from complications,” he told Healio.com. “Nonaccredited centers may not have the resources or expertise for early recognition and management of complications which may lead to their higher death rates.

“The proposed threshold of 50 stapling cases does matter. If you do more than 50 stapling cases, you have better outcomes, but it’s not all about volume. Accreditation status may be more important than volume itself. Even if you perform a high volume [of procedures], but you’re not accredited, you don’t do as well.”

For more information:

Jafari MD. S050: Volume and Outcome Relationship in Bariatric Surgery in the Era of Laparoscopy. Presented at: the Society of American Gastrointestinal and Endoscopic Surgeons 2013 Annual Meeting; April 17-20, Baltimore.