Surgical volume impacts bariatric surgery mortality: A case for centers of excellence

Hollenbeak, Christopher S.; Rogers, Ann M.; Barrus, Bryan; Wadiwala, Irfan; Cooney, Robert N.

doi:10.1016/j.surg.2008.05.013

Cited by 99 publications

(70 citation statements)

References 32 publications

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“…87 However, a clear distinction between perioperative medical and surgical morbidity and mortality is made in only a few publications. 88 There is little doubt that apart from the dynamic of surgical technical expertise, the experience of the endocrinologist, anaesthetists and the extended team as a whole is ultimately the deciding factor in applying "best practise" recommendations 89 to secure low morbidity and even lower mortality.…”

Section: Aspiration Pneumonia 1 Pneumoniamentioning

confidence: 99%

Baseline patient profiling and three-year outcome data after metabolic surgery at a South African centre of excellence

Merwe

Fetter²,

Naidoo³

et al. 2015

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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The bariatric team at Waterfall City Hospital in Gauteng has performed 820 metabolic surgeries under the guidance of an extended team, and with comprehensive recordkeeping. Baseline profiling on more than 50 variables afforded insight into patients undergoing surgery. The available outcome data over three years were comparable with those in the documented literature. The attempted weight loss period prior to agreeing to surgery was 16-18 years. Weight loss in the overall cohort was 29% at three years, with a two-year outcome as follows: diabetes mellitus remission of 81.6% in males and 83.1% in females, full and part-hypertension resolution of 84.8% in males and 74.6% in females, hyperlipidaemia on no treatment of 76.8% in males and 72.1% in females, and sleep apnoea of 75.5% in males and 76.8% in females. Separating out the diabetic group indicated a diabetes mellitus remission of 73.9% in males and 75.1% in females at one year. Improvement in the components of metabolic syndrome was demonstrated in the total cohort. There was an worse profile and higher risk in the male patients. Similarly, higher risk was recorded in the biliopancreatic diversion-duodenal switch cohort, and there was a higher percentage of elected diabetic patients. A wide range of revision surgery was performed, with a higher complication rate (20%) experienced compared to that recorded with the primary surgeries. The morbidity data were separated into medical and surgical morbidity. Major medical morbidity was documented at 5.6% and surgical morbidity at 3.9%. Surgical morbidity in the first 250 cases was reported to be 6% vs. 2.7% in the last 570 cases. Mortality for the cohort was noted to be 0.1%.

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Section: Aspiration Pneumonia 1 Pneumoniamentioning

confidence: 99%

Baseline patient profiling and three-year outcome data after metabolic surgery at a South African centre of excellence

Merwe

Fetter²,

Naidoo³

et al. 2015

Journal of Endocrinology, Metabolism and Diabetes of South Afri

View full text Add to dashboard Cite

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“…14,15 Furthermore, it is important to note in the context of the current series and with the recognition that these procedures were carried out under the supervision of experienced surgeons, that the complexity of the surgery did not translate into increased surgical complications or poorer oncological outcomes (PSM or BCR rates). Interestingly, two recent studies found a higher risk of vesico-urethral strictures in obese men undergoing RP.…”

Section: Discussionmentioning

confidence: 96%

“…These improvements have also been reflected in other surgical spheres. 14,15 Additionally, recent reports from Europe suggesting that oncological outcome is not dependent on BMI 16,17 have challenged the belief that higher BMI patients have poorer disease-related outcomes. Thus, it stands to reason that earlier experiences of poor outcomes in obese patients might now be reduced with refinement of technique and experience operating in this subgroup of patients.…”

Section: Introductionmentioning

confidence: 99%

Radical prostatectomy in obese patients: Improved surgical outcomes in recent years

et al. 2010

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Objectives: Obesity has been proposed as a risk factor for reduced disease-specific survival, increased positive surgical margin (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with prostate cancer. The aim of this study was to clarify the relationship between obesity and surgical outcomes in patients undergoing RP. Methods: Medical records of 491 patients who underwent RP from 2004 to 2007 were retrieved from our institutional database. Patients were divided into three groups based on their body mass index (BMI): <25, 25-30 (overweight) and >30 kg/m (obese). Outcomes after RP were compared between the groups in terms of length of stay, perioperative complications, BCR, PSM and Gleason scores. Results: Age, stage and preoperative prostate-specific antigen were similar between BMI categories. Operating time was prolonged in obese patients (146 vs 135 min, P = 0.01) and blood loss was greater (mean estimated blood loss 640 vs 504 mL, P = 0.02), but did not translate into higher transfusion rates. Early complication rates, PSM rates and Gleason scores were not statistically different between the groups. Significant differences in late outcomes, such as the need for adjunct procedures or BCR (hazard ratio 0.44, 95% CI 0.18-1.09), were not shown. Conclusion: As surgical experience with high BMI patients has developed , RP appears to be a well tolerated procedure in contemporary series, irrespective of BMI. In particular, early outcome parameters, such as PSM and BCR rates, are similar.

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“…[1][2][3][4] These COEs were accredited by one of two surgical professional organizations, the American College of Surgeons (ACS) or American Society for Metabolic and Bariatric Surgery (ASMBS). In addition to other structural measures and processes of care, the accreditation was based on a hospital volume threshold (>125 cases per year).…”

Section: Introductionmentioning

confidence: 99%

Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence

Dimick

Nicholas

Ryan

et al. 2015

Survey of Anesthesiology

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Importance-Starting in 2006, the Center for Medicare and Medicaid Services (CMS) has restricted coverage of bariatric surgery to hospitals designated as "Centers of Excellence" (COE) by two major professional organizations.Objectives-We sought to evaluate whether the implementation of the COE component of the national coverage decision was associated with improved bariatric surgery outcomes in Medicare patients.Design, Setting, and Patients-Using 2004-09 hospital discharge data from 12 states (n=321,464 patients), we studied changes in outcomes in Medicare patients undergoing bariatric surgery. Using a difference-in-difference analytic approach, we evaluated whether the national coverage decision was associated with improved outcomes in Medicare patients above and beyond existing time trends in non-Medicare patients.Main Outcome Measures-Risk-adjusted rates of any complication, serious complications, and reoperations.Results-Over the study period, bariatric surgery outcomes improved in both Medicare and nonMedicare patients and this change was underway prior to the CMS coverage decision. After accounting for patient factors, changes in procedure type, and pre-existing time trends toward improved outcomes, there were no statistically significant improvements in outcomes after (vs. before) implementation of the CMS national coverage decision: any complications (8.0% after vs. 7.0% before; Relative Risk [RR], 1.14, 95% Confidence Interval [CI], 0.95 to 1.33), serious complications (3.3% vs. 3.6%; RR 0.92, 95% CI, 0.62 to 1.22), and reoperation (1.0% vs. 1.1%; RR 0.90, 95% CI, 0.64 to 1.17). In a direct assessment comparing outcomes at hospitals designated as COEs vs. hospitals without COE designation, we found no significant difference in any of the three outcomes: any complications (5.5% vs. 6.0%; RR, 0.98, 95%, 0.90 to 1.06), serious complications (2.2% vs. 2.5%; RR 0.92, 95%CI, 0.84 to 1.00), and reoperations (0.83% vs. 0.96%; RR, 1.00, 95% CI, 0.86 to 1.17).

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Surgical volume impacts bariatric surgery mortality: A case for centers of excellence

Cited by 99 publications

References 32 publications

Baseline patient profiling and three-year outcome data after metabolic surgery at a South African centre of excellence

Baseline patient profiling and three-year outcome data after metabolic surgery at a South African centre of excellence

Radical prostatectomy in obese patients: Improved surgical outcomes in recent years

Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence

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