Development of Consensus-derived Quality Indicators for Bariatric Surgery

Shannon E Stogryn, MBBS, Krista Hardy, MSc, MD, FRCSC, FACS, Jason Park, MEd, MD, FRCSC, FACS, Ashley Vergis, MEd, MD, FRCSC, FACS. University of Manitoba


Our objective was to systematically develop a list of operative report quality indicators for laparoscopic Roux en Y gastric bypass (RYGB) surgery in order to generate validated parameters by which operative documentation for RYGB surgery can be evaluated and improved.

Methods & Procedures

A Delphi protocol was used to determine quality indicators for RYGB reporting. Canadian community and academic bariatric surgeons were recruited along with local physician key stakeholders to participate via a secure web-based platform. We aimed to have one representative bariatric surgeon from all regions in Canada currently performing RYGB. Participants initially submitted potential quality indicators for a RYGB . These indicators were assessed and grouped by theme. Items were then rated on a 9-point Likert scale in subsequent rounds. For consensus, a score of 70% (mean score 6.3) or greater indicated inclusion of an item and 30% (mean score 2.7) or less denoted exclusion. Elements ranging from 30 – 70% consensus were re-circulated by runoff in subsequent rounds to generate the final list of quality indicators.


Four community and four academic bariatric surgeons were invited to participate. We achieved our goal of representation from all provinces performing RYGB in Canada. The 4 local multidisciplinary invitees were comprised of: 1 academic minimally invasive/acute care surgeon, 1 tertiary abdominal radiologist, 1 academic gastroenterologist with expertise in advanced endoscopic techniques, and 1 general surgeon with expertise in synoptic reporting. The initial survey achieved an 83.3% (10/12) response and identified 91 potential quality indicators for consideration. The subsequent survey had a 100% (12/12) response rate. 69 items reached inclusion consensus (Table 1).

Table 1 – Quality Indicators for RYGB
Headings# consensus itemsExample of items
Team demographics10Surgeon
Patient demographics11Pre-operative diagnosis
Intra-operative details18Roux length
Enteroenterostomy details6Stapler # of firings
Gastrojejunostomy details10Pouch length
Closure details8Peterson’s space closure
Post-operative details6Estimated blood loss


This study has established consensus-derived multidisciplinary quality indicators for RYGB operative reports. This information will allow further assessment of the quality of existing documentation and will afford the development of a synoptic report that may ameliorate any deficiencies identified. 

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