Laurent Brunaud1,2, Stephanie Polazzi3, Jean-Christophe Lifante4, Lea Pascal3, David Nocca5, Antoine Duclos3. 1. CHU Nancy - Hospital Brabois Adultes, Department of Digestive, Hepato-Biliary and Endocrine Surgery, and Multidisciplinary Unit for Obesity Surgery (UMCO), Université de Lorraine, 11 allée du morvan, 54511, Vandoeuvre-les-Nancy, France. l.brunaud@chru-nancy.fr. 2. Unité INSERM U954 « Nutrition - génétique et exposition aux risques environnementaux », Faculté de Médecine, Université de Lorraine, 54511, Vandoeuvre-les-Nancy, France. l.brunaud@chru-nancy.fr. 3. Hospices Civils de Lyon, Pôle Information Médicale Évaluation Recherche, Health Services and Performance Research Lab, Université Claude Bernard Lyon 1, 69003, Lyon, France. 4. Centre Hospitalier Lyon Sud, Service de Chirurgie Générale et Endocrinienne, Hospices Civils de Lyon, 69300, Pierre Bénite, France. 5. CHRU Montpellier, Département de Chirurgie Digestive, Hôpital St Eloi, Université de Montpellier, 34000, Montpellier, France.
Abstract
PURPOSE: The volume of bariatric surgery has significantly increased over the past decade with concomitant postoperative outcomes improvement. The goal of this nationwide study was to estimate the volume-outcome relationship in bariatric surgery at the hospital level. MATERIALS AND METHODS: A cross-sectional analysis of all patients who underwent bariatric surgery procedure in France from January 2011 to December 2014 was designed. Volume-outcome relationship was analyzed using generalized estimating equations. RESULTS: We identified 184,332 inpatient stays for bariatric surgical procedures performed in 606 hospitals. Health care institutions performing more than 200 bariatric cases per year were significantly associated with shorter average length of stay (p < 0.001) and less frequent need for intensive or critical care unit (p = 0.003) during the index stay in comparison with lower volume institutions. Reoperations rate increased from 3.1% [95% CI, 2.8-3.3] (n = 5627) at 1 month to 4.9% [4.6-5.2] at 3 months and 8.2% [7.8-8.7] at 6 months. The risk of reoperation after gastric bypass was 1.37 times less frequent in higher volume institutions (≥ 200 inpatient stays per year, p = 0.003), while it was 1.26 times more frequent after gastric banding in higher volume institutions (p = 0.057) and was unaltered regarding sleeve gastrectomy (p = 0.819). CONCLUSION: This study showed for the first time in bariatric surgery that reoperation rate after gastric bypass or sleeve significantly increased at 3 and 6 months postoperatively. Health care institutions performing more than 200 bariatric cases per year were significantly associated with improved postoperative outcomes and less frequent need for reoperation.
PURPOSE: The volume of bariatric surgery has significantly increased over the past decade with concomitant postoperative outcomes improvement. The goal of this nationwide study was to estimate the volume-outcome relationship in bariatric surgery at the hospital level. MATERIALS AND METHODS: A cross-sectional analysis of all patients who underwent bariatric surgery procedure in France from January 2011 to December 2014 was designed. Volume-outcome relationship was analyzed using generalized estimating equations. RESULTS: We identified 184,332 inpatient stays for bariatric surgical procedures performed in 606 hospitals. Health care institutions performing more than 200 bariatric cases per year were significantly associated with shorter average length of stay (p < 0.001) and less frequent need for intensive or critical care unit (p = 0.003) during the index stay in comparison with lower volume institutions. Reoperations rate increased from 3.1% [95% CI, 2.8-3.3] (n = 5627) at 1 month to 4.9% [4.6-5.2] at 3 months and 8.2% [7.8-8.7] at 6 months. The risk of reoperation after gastric bypass was 1.37 times less frequent in higher volume institutions (≥ 200 inpatient stays per year, p = 0.003), while it was 1.26 times more frequent after gastric banding in higher volume institutions (p = 0.057) and was unaltered regarding sleeve gastrectomy (p = 0.819). CONCLUSION: This study showed for the first time in bariatric surgery that reoperation rate after gastric bypass or sleeve significantly increased at 3 and 6 months postoperatively. Health care institutions performing more than 200 bariatric cases per year were significantly associated with improved postoperative outcomes and less frequent need for reoperation.
Authors: Andrea Lazzati; Etienne Audureau; François Hemery; Anne-Sophie Schneck; Jean Gugenheim; Daniel Azoulay; Antonio Iannelli Journal: Surgery Date: 2015-09-14 Impact factor: 3.982
Authors: Mark D Smith; Emma Patterson; Abdus S Wahed; Steven H Belle; Anita P Courcoulas; David Flum; Saurabh Khandelwal; James E Mitchell; Alfons Pomp; Walter J Pories; Bruce Wolfe Journal: Surg Obes Relat Dis Date: 2012-10-30 Impact factor: 4.734
Authors: Hude Quan; Vijaya Sundararajan; Patricia Halfon; Andrew Fong; Bernard Burnand; Jean-Christophe Luthi; L Duncan Saunders; Cynthia A Beck; Thomas E Feasby; William A Ghali Journal: Med Care Date: 2005-11 Impact factor: 2.983