Konstantinos Spaniolas, MD1, Stella T Tsui, BS1, Jie Yang, PhD2, Yiwei Fu, MS3, Maria Altieri, MD4, Mark A Talamini, MD, MBA1, Aurora D Pryor, MD1. 1Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery. Department of Surgery. Stony Brook University Medical Center. Stony Brook, New York, USA, 2Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York, USA, 3Department of Applied Mathematics and Statistics, Stony Brook University. Stony Brook, New York, USA, 4Section of Minimally Invasive Surgery, Washington University Medical Center. St. Louis, Missouri, USA
Introduction: Laparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric procedure. The need for subsequent reoperation is used as a quality indicator for such intervention. In addition, future reoperations have a significant effect on the cost effectiveness of bariatric surgery. Although bariatric center procedural volume has been associated with early perioperative safety, data on the effect of such volume and long-term outcomes after SG is limited. This study aims to examine the relationship between annual bariatric center SG volume and the incidence of revisions or conversions (RC) after SG.
Methods: The New York Statewide Planning and Research Cooperative System database was used to identify all patients who underwent SG between 2006 and 2012. Subsequent RC events were captured up to 2016. To distribute the patients equally into three categories, bariatric centers having annual SG volume less than 45, between 45-65 and greater than 65 were defined as low, medium and high volume respectively. Multivariable Cox proportional hazard regression analysis was performed to compare the risk of having RC among centers with different yearly sleeve volumes.
Results: We identified 8389 patients who underwent SG. The majority were female (77.8%) with commercial insurance (90%). The overall estimated cumulative incidence of RC was 0.5% (95% CI, 0.3%-0.6%) at 1 year, 6.2% (95% CI, 5.4%-7.0%) at 5 years, and 15.3% (95% CI, 12.6%-18.0%) at 8 years after SG (Figure). The estimated cumulative incidences of RC for low, medium and high volume centers at 8 years after SG were 16.7% (95% CI, 11.1%-22.3%), 15.5% (95% CI, 11.2%-19.8%) and 13.7% (95% CI, 9.4%-17.9%) respectively. Among bariatric centers, both low (hazard ratio 1.54; 95% CI, 1.14-2.08) and medium volume (hazard ratio 1.34; 95% CI, 1.02-1.77) centers have higher risk of having RC compared to high volume centers. Low and medium volume centers have comparable risk of having RC (hazard ratio 1.15; 95%, 0.87-1.51). Patients having the initial SG performed in low volume centers were the least likely to have RC in the same institution (46.6% of low volume, 12.9% of medium volume, 23.0% of high volume centers).
Conclusion: Patients undergoing SG at high volume bariatric centers experience lower risk of subsequent RC. This effect persists after adjusting for patient level factors. These data support the ongoing use of annual volume requirements for center accreditation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91985
Program Number: S075
Presentation Session: Bariatric II – Revisions
Presentation Type: Podium