Fady Saleh1, Aristithes G Doumouras1, Scott Gmora1, Mehran Anvari1, Dennis Hong1. 1. Division of General Surgery (Saleh, Doumouras, Gmora, Anvari, Hong), St. Joseph's Healthcare; Department of Surgery (Doumouras, Gmora, Anvari, Hong), McMaster University, Hamilton, Ont.
Abstract
BACKGROUND: Bariatric surgery centres of excellence are relatively new in Canada and were first started in Ontario in 2009. This study presents short-term outcomes of Canada's largest bariatric collaborative, from Ontario, during its first 3 years. METHODS: We performed a population-based cohort study that included all patients (age ≥ 18) who received a Roux-en-Y gastric bypass or sleeve gastrectomy for the purpose of weight loss from March 2009 to April 2012 within Ontario. Data were derived from the Canadian Institute for Health Information Discharge Abstract and Hospital Morbidity Databases. Primary outcomes included short-term overall complication rate, reoperation rate, anastomotic leak rate and death. Hierarchical logistic regression was used to identify risk factors for overall complications. A median odds ratio (OR) was used to compare risk-adjusted complication rates across centres of excellence. RESULTS: A total of 5007 procedures (91.7% Roux-en-Y gastric bypass, 8.3% sleeve gastrectomy) were performed during the 3-year study period, with an overall complication rate of 11.7% (95% confidence interval [CI] 10.8%-12.6%). The leak rate was 0.84% (95% CI 0.61%-1.13%), the reoperation rate was 4.6% (95% CI 4.0%-5.2%) and mortality was 0.16% (95% CI 0.07%-0.31%). Male sex, chronic kidney disease and osteoarthritis were identified as risk factors for overall complications (p value < 0.05). The median ORs across centres of excellence, calculated for both overall complications and reoperation rate, were 1.76 and 1.49, respectively. INTERPRETATION: Bariatric surgery within Ontario has similar short-term outcomes to those of other major world centres. The variability of outcomes within centres of excellence highlights areas for program quality improvement.
BACKGROUND: Bariatric surgery centres of excellence are relatively new in Canada and were first started in Ontario in 2009. This study presents short-term outcomes of Canada's largest bariatric collaborative, from Ontario, during its first 3 years. METHODS: We performed a population-based cohort study that included all patients (age ≥ 18) who received a Roux-en-Y gastric bypass or sleeve gastrectomy for the purpose of weight loss from March 2009 to April 2012 within Ontario. Data were derived from the Canadian Institute for Health Information Discharge Abstract and Hospital Morbidity Databases. Primary outcomes included short-term overall complication rate, reoperation rate, anastomotic leak rate and death. Hierarchical logistic regression was used to identify risk factors for overall complications. A median odds ratio (OR) was used to compare risk-adjusted complication rates across centres of excellence. RESULTS: A total of 5007 procedures (91.7% Roux-en-Y gastric bypass, 8.3% sleeve gastrectomy) were performed during the 3-year study period, with an overall complication rate of 11.7% (95% confidence interval [CI] 10.8%-12.6%). The leak rate was 0.84% (95% CI 0.61%-1.13%), the reoperation rate was 4.6% (95% CI 4.0%-5.2%) and mortality was 0.16% (95% CI 0.07%-0.31%). Male sex, chronic kidney disease and osteoarthritis were identified as risk factors for overall complications (p value < 0.05). The median ORs across centres of excellence, calculated for both overall complications and reoperation rate, were 1.76 and 1.49, respectively. INTERPRETATION: Bariatric surgery within Ontario has similar short-term outcomes to those of other major world centres. The variability of outcomes within centres of excellence highlights areas for program quality improvement.
Authors: Matthew M Hutter; Sheldon Randall; Shukri F Khuri; William G Henderson; William M Abbott; Andrew L Warshaw Journal: Ann Surg Date: 2006-05 Impact factor: 12.969
Authors: Bruce L Hall; Barton H Hamilton; Karen Richards; Karl Y Bilimoria; Mark E Cohen; Clifford Y Ko Journal: Ann Surg Date: 2009-09 Impact factor: 12.969
Authors: David E Arterburn; Maren K Olsen; Valerie A Smith; Edward H Livingston; Lynn Van Scoyoc; William S Yancy; George Eid; Hollis Weidenbacher; Matthew L Maciejewski Journal: JAMA Date: 2015-01-06 Impact factor: 56.272
Authors: A M van Dishoeck; M B G Koek; E W Steyerberg; B H B van Benthem; M C Vos; H F Lingsma Journal: Br J Surg Date: 2013-01-21 Impact factor: 6.939
Authors: Daniel Henneman; Annelotte C M van Bommel; Alexander Snijders; Heleen S Snijders; Rob A E M Tollenaar; Michel W J M Wouters; Marta Fiocco Journal: Ann Surg Date: 2014-05 Impact factor: 12.969
Authors: Ted D Adams; Lance E Davidson; Sheldon E Litwin; Ronette L Kolotkin; Michael J LaMonte; Robert C Pendleton; Michael B Strong; Russell Vinik; Nathan A Wanner; Paul N Hopkins; Richard E Gress; James M Walker; Tom V Cloward; R Tom Nuttall; Ahmad Hammoud; Jessica L J Greenwood; Ross D Crosby; Rodrick McKinlay; Steven C Simper; Sherman C Smith; Steven C Hunt Journal: JAMA Date: 2012-09-19 Impact factor: 56.272
Authors: Elaine M Burns; Haris Naseem; Alex Bottle; Antonio Ivan Lazzarino; Paul Aylin; Ara Darzi; Krishna Moorthy; Omar Faiz Journal: BMJ Date: 2010-08-26
Authors: Aristithes G Doumouras; Fady Saleh; Sama Anvari; Scott Gmora; Mehran Anvari; Dennis Hong Journal: Obes Surg Date: 2017-11 Impact factor: 4.129
Authors: Jerry T Dang; Iran Tavakoli; Noah Switzer; Valentin Mocanu; Xinzhe Shi; Chris de Gara; Daniel W Birch; Shahzeer Karmali Journal: Can J Surg Date: 2020-04-17 Impact factor: 2.089
Authors: Katherine J P Schwenger; Sandra E Fischer; Timothy D Jackson; Allan Okrainec; Johane P Allard Journal: Obes Surg Date: 2018-04 Impact factor: 4.129
Authors: Jean-Eric Tarride; Aristithes G Doumouras; Dennis Hong; J Michael Paterson; Semra Tibebu; Francis Nguyen; Richard Perez; Valerie H Taylor; Feng Xie; Vanessa Boudreau; Eleanor Pullenayegum; David R Urbach; Mehran Anvari Journal: JAMA Netw Open Date: 2021-09-01
Authors: Jean-Eric Tarride; Aristithes G Doumouras; Dennis Hong; J Michael Paterson; Semra Tibebu; Richard Perez; Julia Ma; Valerie H Taylor; Feng Xie; Vanessa Boudreau; Eleanor Pullenayegum; David R Urbach; Mehran Anvari Journal: JAMA Surg Date: 2020-09-16 Impact factor: 14.766