Kyle Hunt, MD, FRCSC1, Aristithes Doumouras, MD2, Dennis Hong, MD, MSc, FRCSC, FACS2. 1University of Toronto, 2McMaster University
INTRODUCTION: Higher operative volumes are associated with improved patient outcomes in bariatric surgery. As studies have shown that experience and learned skills in surrogate surgical operations may be transferrable to a specific index operation, the question remains as to whether this also applies to bariatric surgery. The goal of the study is to investigate whether bariatric surgeons who perform high volumes of non-bariatric surgery show an improvement in their patient outcomes after bariatric surgery.
METHODS AND PROCEDURES: This was a retrospective population-based review of all patients aged >18y receiving a bariatric procedure in Ontario from 2008 to 2015, using Canadian Institute of Health Information databases. Individual surgeon outcome data of 29 bariatric surgeons was collected for analysis and grouped for bariatric and non-bariatric surgeries. The main outcome of interest for this study was all-cause morbidity after bariatric surgery during the index admission. All-cause morbidity included any documented complication which extended length of stay by 24 hours or required reoperation. Bariatric cases included Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. Non-bariatric cases included all general surgery cases except for hernia repairs, both open and laparoscopic (cholecystectomy, colectomy, appendectomy, etc.). Univariate analysis was performed with Chi-squared test. Multivariate analysis with adjustment using a random effects model for surgeon and hospital-level correlation was performed, with multilevel logistic regression performed using Markov Chain modelling for the final model.
RESULTS: For bariatric surgeons in Ontario, the average number of bariatric and non-bariatric operations per year was 78 (88% RYGB) and 72 respectively. A significantly higher proportion of complications after bariatric surgery was seen in older patients, those with hypertension, severe diabetes, and coronary artery disease. A reduction in complications was seen when bariatric surgeons exceeded 50 bariatric cases (OR 0.66, CI 0.50-0.86, p=0.002). As for performance of non-bariatric surgery, higher volume was not shown to significantly affect complication rates after bariatric surgery, even when exceeding 100 cases (OR 0.95, CI 0.71-1.25, p=0.66).
CONCLUSION(S): This study provides evidence to suggest that for bariatric surgeons, experience and skills acquired in performing non-bariatric surgery may not translate to improved outcomes in bariatric surgery. As seen in this study, improvement in bariatric surgical outcomes is likely more dependent on experience specifically performing bariatric procedures. As there may be no benefit acquired from performing surrogate procedures, this may have implications in the design of subspecialty training programs and for accreditation purposes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88146
Program Number: P321
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster