Aristithes G Doumouras1,2, Fady Saleh3, Sama Anvari3, Scott Gmora4,3, Mehran Anvari4,3, Dennis Hong4,3. 1. Department of Surgery, McMaster University, Hamilton, ON, Canada. aristithes.doumouras@medportal.ca. 2. Division of General Surgery, St. Joseph's Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. aristithes.doumouras@medportal.ca. 3. Division of General Surgery, St. Joseph's Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. 4. Department of Surgery, McMaster University, Hamilton, ON, Canada.
Abstract
BACKGROUND: Evaluating how morbidity and costs evolve for new bariatric centers is vital to understanding the expected length of time required to reach optimal outcomes and cost efficiencies. Accordingly, the objective of this study was to evaluate how morbidity and costs changed longitudinally during the first 5 years of a regionalized center of excellence system. METHODS: This was a longitudinal analysis of the first 5 years of a bariatric center of excellence system. The main outcomes of interest were all-cause morbidity and cost for the index admission. Predictors of interest included patient demographics, comorbidities, annual hospital and surgeon volume, fellowship teaching center status, and year of procedure. Hierarchical regression models were used to determine predictors of morbidity and costs. RESULTS: Procedures done in 2012 (OR 0.65, 95%CI 0.52-0.79; p < 0.001), 2013 (OR 0.63, 95%CI 0.51-0.78; p < 0.001), and 2014 (OR 0.53, 95%CI 0.43-0.65; p < 0.001) all conferred a significantly lower odds of morbidity when compared to the initial 2009/2010 years. Surgeon volume was associated with a decreased odds of morbidity as for each increase in 25 bariatric cases per year the odds of all-cause morbidity was 0.94 lower (95%CI 0.88-1.00; p = 0.04). There was no significant variation at the hospital or surgeon level in perioperative outcomes. CONCLUSION: This study determined that volume was important even for high resource, fellowship-trained surgeons. It also found a decrease in morbidity over time for new centers. Lastly, there was little variation in outcomes across hospitals and surgeons suggesting that strict accreditation standards can help to ensure high quality across hospital sites.
BACKGROUND: Evaluating how morbidity and costs evolve for new bariatric centers is vital to understanding the expected length of time required to reach optimal outcomes and cost efficiencies. Accordingly, the objective of this study was to evaluate how morbidity and costs changed longitudinally during the first 5 years of a regionalized center of excellence system. METHODS: This was a longitudinal analysis of the first 5 years of a bariatric center of excellence system. The main outcomes of interest were all-cause morbidity and cost for the index admission. Predictors of interest included patient demographics, comorbidities, annual hospital and surgeon volume, fellowship teaching center status, and year of procedure. Hierarchical regression models were used to determine predictors of morbidity and costs. RESULTS: Procedures done in 2012 (OR 0.65, 95%CI 0.52-0.79; p < 0.001), 2013 (OR 0.63, 95%CI 0.51-0.78; p < 0.001), and 2014 (OR 0.53, 95%CI 0.43-0.65; p < 0.001) all conferred a significantly lower odds of morbidity when compared to the initial 2009/2010 years. Surgeon volume was associated with a decreased odds of morbidity as for each increase in 25 bariatric cases per year the odds of all-cause morbidity was 0.94 lower (95%CI 0.88-1.00; p = 0.04). There was no significant variation at the hospital or surgeon level in perioperative outcomes. CONCLUSION: This study determined that volume was important even for high resource, fellowship-trained surgeons. It also found a decrease in morbidity over time for new centers. Lastly, there was little variation in outcomes across hospitals and surgeons suggesting that strict accreditation standards can help to ensure high quality across hospital sites.
Authors: Mehraneh D Jafari; Fariba Jafari; Monica T Young; Brian R Smith; Michael J Phalen; Ninh T Nguyen Journal: Surg Endosc Date: 2013-08-13 Impact factor: 4.584
Authors: Aristithes G Doumouras; Fady Saleh; Sama Anvari; Scott Gmora; Mehran Anvari; Dennis Hong Journal: Ann Surg Date: 2018-03 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: Alfredo M Carbonell; Amy E Lincourt; Brent D Matthews; Kent W Kercher; Ronald F Sing; B Todd Heniford Journal: Am Surg Date: 2005-04 Impact factor: 0.688
Authors: Lars Sjöström; Markku Peltonen; Peter Jacobson; Sofie Ahlin; Johanna Andersson-Assarsson; Åsa Anveden; Claude Bouchard; Björn Carlsson; Kristjan Karason; Hans Lönroth; Ingmar Näslund; Elisabeth Sjöström; Magdalena Taube; Hans Wedel; Per-Arne Svensson; Kajsa Sjöholm; Lena M S Carlsson Journal: JAMA Date: 2014-06-11 Impact factor: 56.272
Authors: Justin B Dimick; Nancy J Birkmeyer; Jonathan F Finks; David A Share; Wayne J English; Arthur M Carlin; John D Birkmeyer Journal: JAMA Surg Date: 2014-01 Impact factor: 14.766
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