Effect of Surgeon Volume on Sleeve Gastrectomy Outcomes

Celio, Adam C.; Kasten, Kevin R.; Brinkley, Jason; Chung, Ann Y.; Burruss, Matthew B.; Pories, Walter J.; Spaniolas, Konstantinos

doi:10.1007/s11695-016-2190-4

Cited by 21 publications

(9 citation statements)

References 19 publications

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“…This value of 50 cases per year has been used to define high-volume surgeons for a number of surgical procedures. 2,8,16,24 For facilities, we used 125 cases per year as a cutoff for high volume. This value put 51% of cases in the low-volume category and 49% in the high-volume category.…”

Section: Methodsmentioning

confidence: 99%

Disparities in Cost and Access by Caseload for Arthroscopic Rotator Cuff Repair: An Analysis of 18,616 Cases

Bokshan

Mehta

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Surgeon caseload has been shown to affect both health and economic outcomes in arthroscopic rotator cuff repair. Although previous studies have investigated disparities in access to care, little is known about disparities between low- and high-volume surgeons and facilities. Purpose: To identify where disparities may exist regarding access to high-volume surgeons and facilities. Study Design: Cross-sectional study. Methods: Univariate analysis was performed to analyze differences in the caseload between low- and high-volume surgeons and facilities. Cutoff values were set at 50 cases per year for high-volume surgeons and 125 cases annually for high-volume facilities. Multiple linear regression was then used to develop a cost model incorporating all variables significant under univariate analysis. We collected 18,616 cases with Current Procedural Terminology code 29827 (“arthroscopic rotator cuff repair”) from the 2014 Florida State Ambulatory Surgery and Services Databases. Results: A greater proportion of the caseload for low-volume surgeons and facilities was composed of patients who were of lower socioeconomic status, had government-subsidized insurance, or lived in areas with low-income ZIP codes. Low-volume surgeons and facilities also had higher total charges, higher postoperative admission rates, and lower distal clavicle excision rates ( P < .001). In our cost model, a low facility volume significantly increased costs. Subacromial decompression, postoperative admission, distal clavicle excision, male sex, and government-subsidized insurance were all significant factors for increased costs in multivariate cost analysis. Conclusion: There are disparities in access to high-volume surgeons and facilities for patients undergoing arthroscopic rotator cuff repair in Florida. Patients with a lower socioeconomic status, government-subsidized insurance, and low income all faced decreased access to these high-volume groups. High-volume surgeons and facilities were associated with lower total charges, higher rates of distal clavicle excision, and lower readmission rates. Low-volume facilities added a significant amount of cost, even when controlling for all other significant variables. It is important for providers to be aware of these disparities and work to address them in their own practices.

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Section: Methodsmentioning

confidence: 99%

Disparities in Cost and Access by Caseload for Arthroscopic Rotator Cuff Repair: An Analysis of 18,616 Cases

Bokshan

Mehta

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…We had a low number of leaks, which might have diminished the value of the leak test. We presume this is due to the experience of the surgeons who perform these operations, as this is known to have a positive impact on outcomes [17]. In our experience, leaks can be avoided by including some important technical points: avoidance of distal stenosis and/or twist, especially in SG; adequate compression time during stapling; gentle tissue handling; avoiding thermal damage at anastomosis and staple line; and staying away from the gastroesophageal junction.…”

Section: Discussionmentioning

confidence: 95%

Bariatrik cerrahide rutin intraoperatif ve postoperatif kaçak testlerine ihtiyaç var mı?

Yardımcı¹,

Yapalak²

2020

Archives of Clinical and Experimental Medicine

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Aim: We aimed to evaluate the efficacy of the results of intraoperative methylene blue test and postoperative upper gastrointestinal contrast graphies for detecting leakage in both primary and revisional bariatric surgery. Methods: Two-hundred-eighty-seven patients, who underwent primary and revision bariatric surgery and routine intraoperative methylene blue test and upper gastrointestinal contrast studies postoperatively for leakage were included in the study. Patients' demographic characteristics, comorbidities, length of hospital stay, operation time, intraoperative, and postoperative complications were analyzed retrospectively. Results: In our study, 256 of 287 (89.1%) patients underwent primary surgery, 221 (75.7%) patients were female, the mean patient age was 38.4 ± 11.9 years, and the mean body mass index was 44.3 ± 7.6 kg/m 2. The number of patients who had previous abdominal surgery and comorbidity was 108 (37.6%) and 149 (51.9%), respectively. Leakage was detected by a methylene blue test in one (0.3%) patient who underwent oneanastomosis gastric bypass surgery. In one (3.2%) patient who underwent revisional surgery with negative results of methylene blue test, leakage was detected on the first postoperative day due to the clinical findings. There was no leakage detected in any patient with postoperative swallow graphies. There was no statistical difference in leakage between primary and revisional surgery groups (p = 0.23). There was no mortality. Conclusion: It could be unnecessary to use postoperative gastrointestinal contrast studies in both primary and revisional bariatric surgery, but the routine use of the intraoperative methylene blue test could be considered useful due to its positive results for the detection of leakage.

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“…Though our cohort is large, we feel the low number of leaks may have diminished the value of a leak test. We postulate this is due to the experience of the surgeons performing these operations, as this is known to have a positive impact on outcomes [20] , [21] .…”

Section: Discussionmentioning

confidence: 99%

The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study

Kirby

Macano

Nyasavajjala

et al. 2017

Annals of Medicine &Amp; Surgery

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IntroductionLeak following bariatric surgery continues to be associated with morbidity and rarely mortality. With improvement in surgical techniques and stapler design, leak rates have reduced drastically. Intra-operative high pressure Methylene blue leak test (HPMB) is one of the techniques employed to confirm integrity of anastomoses and staple lines. Despite this, evidence for its use remains limited. We evaluated the role of HPMB in detecting and preventing leaks.MethodsA retrospective cohort of consecutive patients who underwent primary or revisional Laparoscopic Sleeve Gastrectomy (SG) or Laparoscopic Roux-en-Y Gastric bypass (RYGB) under the care of five surgeons in three centres across Birmingham, UK, between 2012 and 2016 were assessed. All patients had routine HPMB at the end of the procedure. Demographics, HPMB positivity, and post operative leaks were recorded.Results924 patients underwent bariatric surgery: 696(75.3%) RYGB, and 225(24.3%) SG. 85(9.2%) were revisional procedures.Two HPMB were positive, which necessitated staple or suture line reinforcement with sutures intra-operatively. The patients had an uneventful recovery. 5 patients had postoperative leaks, all of whom had negative intraoperative HPMB: 3 SG patients; and 2 RYGB patients (gastro-jejunostomy anastomotic leaks). There was no statistically significant relationship between positive HPMB and anastomotic leak (Fishers exact test; p = 1).ConclusionDespite routine use of methylene blue dye test in 924 patients, there were only two positive tests. Whilst HPMB may demonstrate technical failure, this study suggests that there is no role for its routine use in primary bariatric surgery. Discontinuation of this practice would reduce risk of anaphylaxis to the dye, cost, and intra-operative time.

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Effect of Surgeon Volume on Sleeve Gastrectomy Outcomes

Cited by 21 publications

References 19 publications

Disparities in Cost and Access by Caseload for Arthroscopic Rotator Cuff Repair: An Analysis of 18,616 Cases

Disparities in Cost and Access by Caseload for Arthroscopic Rotator Cuff Repair: An Analysis of 18,616 Cases

Bariatrik cerrahide rutin intraoperatif ve postoperatif kaçak testlerine ihtiyaç var mı?

The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study

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