The Relationship Between Hospital Volume and Outcome in Bariatric Surgery at Academic Medical Centers

Nguyen, Ninh T.; Paya, Mahbod; Stevens, C. Melinda; Mavandadi, Shahrzad; Zainabadi, Kambiz; Wilson, Samuel E.

doi:10.1097/01.sla.0000140752.74893.24

Cited by 371 publications

(219 citation statements)

References 12 publications

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“…There is an association between increased hospital volumes with improved outcomes in a number of complex, high-risk operations [20,22,25]. The current study similarly identified a relationship between incremental annual increase of 10 case with improved outcomes.…”

Section: Discussionsupporting

confidence: 65%

“…One of the first studies examining the relationship between hospital volume and surgical outcomes was published in 1979 by Luft et al [14]. Since that time, there have been numerous studies published on the association between hospital volume and surgical outcomes for complex, high-risk operations [15][16][17][18][19][20][21]. The overwhelming majority of these studies have demonstrated that high-volume hospitals have improved outcomes, particularly for high-risk operations.…”

Section: Introductionmentioning

confidence: 99%

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Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

et al. 2017

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

et al. 2017

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“…This method of risk assessment has been verified and validated by the Agency for Healthcare Research and Quality (AHRQ) [33]. Severity of illness accounts for a number of patient variables and weights them in the context of patient illness, including other co-morbid conditions, age and diagnoses [34][35][36][37][38][39][40][41].…”

Section: Methodsmentioning

confidence: 99%

“…However, a recent study using that database identified fewer than one-half as many patients as this study (n = 688) and had no means of identifying use of HBOT as an adjunct to surgical debridement [72,73]. The UHC's risk-stratification method has been validated by the AHRQ and has been used by a number of other researchers to adjust outcomes after various interventions [34][35][36][37][38][39][40][41]72]. Therefore, despite the possible limitations of our severity of illness measure, given the database's power to yield a relatively large cohort for a rare disease, and an ever-rarer intervention, we believe that our analysis is meaningful for clinicians considering whether or not to use HBOT to treat NSTI.…”

mentioning

confidence: 99%

Not Just Full of Hot Air: Hyperbaric Oxygen Therapy Increases Survival in Cases of Necrotizing Soft Tissue Infections

Shaw

Psoinos

Emhoff

et al. 2014

Surgical Infections

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Background: The utility of hyperbaric oxygen therapy (HBOT) in the treatment of necrotizing soft tissue infections (NSTIs) has not been proved. Previous studies have been subject to substantial selection bias because HBOT is not available universally at all medical centers, and there is often considerable delay associated with its initiation. We examined the utility of HBOT for the treatment of NSTI in the modern era by isolating centers that have their own HBOT facilities. Methods: We queried all centers in the University Health Consortium (UHC) database from 2008 to 2010 that have their own HBOT facilities (n = 14). Cases of NSTI were identified by International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes, which included Fournier gangrene (608.83), necrotizing fasciitis (728.86), and gas gangrene (040.0). Status of HBOT was identified by the presence (HBOT) or absence (control) of ICD-9 procedure code 93.95. Our cohort was risk-stratified and matched by UHC's validated severity of illness (SOI) score. Comparisons were then made using univariate tests of association and multivariable logistic regression. Results: There were 1,583 NSTI cases at the 14 HBOT-capable centers. 117 (7%) cases were treated with HBOT. Univariate analysis showed that there was no difference between HBOT and control groups in hospital length of stay, direct cost, complications, and mortality across the three less severe SOI classes (minor, moderate, and major). However, for extreme SOI the HBOT group had fewer complications (45% vs. 66%; p < 0.01) and fewer deaths (4% vs. 23%; p < 0.01). Multivariable analysis showed that patients who did not receive HBOT were less likely to survive their index hospitalization (odds ratio, 10.6; 95% CI 5.2-25.1). Conclusion: At HBOT-capable centers, receiving HBOT was associated with a significant survival benefit. Use of HBOT in conjunction with current practices for the treatment of NSTI can be both a cost-effective and life-saving therapy, in particular for the sickest patients.

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“…The 30‐day operation mortality was reported to be 2% in 2004 and decreased to 0.2% in 2009 through the high‐quality bariatric center program in the USA 19, 20. Well‐experienced surgeons, fully trained in laparoscopic techniques and proctorship, teamwork and agdequate volume are important for a high‐quality bariatric surgical center 21. Improvements in technology, operative techniques, results of clinical trials and accumulation of experience all contributed to this progress 22.…”

Section: Increase In Numbers and Better Safetymentioning

confidence: 99%

Recent advancements in bariatric/metabolic surgery

Lee

Almalki

2017

Annals of Gastroent Surgery

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Obesity and type 2 diabetes mellitus (T2DM) are currently two pan‐endemic health problems worldwide and are associated with considerable increase in morbidity and mortality. Both diseases are closely related and very difficult to control by current medical treatment, including diet, drug therapy and behavioral modification. Bariatric surgery has proven successful in treating not just obesity but also in significantly decreasing overall obesity‐associated morbidities as well as improving quality of life in severely obese patients (body mass index [BMI] >35 kg/m2). A rapid increase in bariatric surgery started in the 2000s when the laparoscopic surgical technique was introduced into this field. Many new procedures had been developed and changed the face of modern bariatric surgery. Recently, bariatric surgery played as gastrointestinal metabolic surgery has been proposed as a new treatment modality for obesity‐related T2DM for patients with BMI >35 kg/m2. Strong evidence has demonstrated that bariatric/metabolic surgery is an effective and durable treatment for obese T2DM patients. Bariatric/metabolic surgery is now becoming an important surgical division. The present article examines and discusses recent advancements in bariatric/metabolic surgery and covers four major fields: (i) the rapid increase in numbers and better safety; (ii) new procedures with better outcomes; (iii) from bariatric to metabolic surgery; and (iv) understanding the mechanisms and personalized treatment.

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The Relationship Between Hospital Volume and Outcome in Bariatric Surgery at Academic Medical Centers

Cited by 371 publications

References 12 publications

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

Not Just Full of Hot Air: Hyperbaric Oxygen Therapy Increases Survival in Cases of Necrotizing Soft Tissue Infections

Recent advancements in bariatric/metabolic surgery

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