Timothy D Jackson, MD MPH, Matthew M Hutter, MD MPH. Codman Center for Clinical Effectiveness, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA & Department of Surgery, University of Toronto, University Health Network, Toronto, ON, Canada
Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and laparoscopic adjustable banding (LAGB) each have unique risk/benefit profiles and are all considered acceptable surgical options for the treatment of morbid obesity. The choice of procedure is a shared decision between both patient and providers. The application of current outcomes data to generate a risk/benefit display on a web-based platform has the potential to better inform the informed consent process. The objective of the present study is to develop a clinical predictive model to better define the expected risk/benefits profiles across these three procedures for a given patient to facilitate decision-making in the clinical setting.
The ACS-BSCN accreditation program maintains a large prospective, multi-institutional, observational database that collects clinically rich data using trained reviewers and standardized definitions. The study cohort will include an updated dataset of patients undergoing RYGB, SG, and LAGB from July 2007. A risk-adjusted analysis will identify patient factors predictive of bariatric specific end points for each procedure type. The feasibility of this methodology within this dataset has recently been demonstrated by Hutter et al (Ann Surg, 2011). Model design will allow for the incorporation of updated datasets from the ACS-BSCN centers. The predictive model will be assessed for performance, validated and implemented on a web-based format for widespread use.
This will be an interim report of the study funded by the 2010 SAGES Career Development Award and we anticipate our findings to be available at the time of the meeting. Based on entered patient characteristics identified in the model, reports provide current risk estimates of mortality, morbidity, medical and surgical complications, conversion to open, reoperation, and length of stay. Estimates of expected benefits are reported as change in BMI, %excess body weight loss and resolution of comorbidities (diabetes, hypertension, hyperlipidemia, sleep apnea, gastroesophageal reflux) up to one year. Preliminary design is depicted in Figure 1.
The development and implementation of a risk/benefit calculator based on high quality, “real world” data from the ACS-BSCN has the potential to better inform the consent process, aid in the selection of procedure type, and help further optimize outcomes from bariatric surgery. Availability of this model in a web-based format will enable widespread application in the clinical setting. Further evaluation will investigate the utility of this tool in the procedure selection process.
Session Number: Poster – Poster Presentations
Program Number: P470