Daniel Gero1, Dimitri A Raptis1,2, Wouter Vleeschouwers3, Sophie L van Veldhuisen4, Andres San Martin5, Yao Xiao6,7, Manoela Galvao8, Marcoandrea Giorgi9, Marine Benois10, Felipe Espinoza11, Marianne Hollyman12, Aaron Lloyd13, Hanna Hosa1, Henner Schmidt1, José Luis Garcia-Galocha14, Simon van de Vrande15, Sonja Chiappetta16, Emanuele Lo Menzo17, Cristina Mamédio Aboud18, Sandra Gagliardo Lüthy19, Philippa Orchard20, Steffi Rothe21, Gerhard Prager21, Dimitri J Pournaras20, Ricardo Cohen18, Raul Rosenthal17, Rudolf Weiner16, Jacques Himpens15,22, Antonio Torres14, Kelvin Higa13, Richard Welbourn12, Marcos Berry11, Camilo Boza11, Antonio Iannelli10, Sivamainthan Vithiananthan9, Almino Ramos8, Torsten Olbers7,23, Matias Sepúlveda5, Eric J Hazebroek4, Bruno Dillemans3, Roxane D Staiger1, Milo A Puhan24, Ralph Peterli19, Marco Bueter1. 1. Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland. 2. Department of Hepatobiliary and Pancreas Surgery and Liver Transplantation, Royal Free Hospital, London, UK. 3. Department of General Surgery, AZ Sint Jan Brugge-Oostende, Brugge, Belgium. 4. Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, The Netherlands. 5. Bariatric and Metabolic Surgery Center, Dipreca Hospital, Las Condes, Santiago, Chile. 6. Department of Surgery, Varberg Hospital, Varberg, Sweden. 7. Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 8. GastroObeso-Center-Advanced Institute In Bariatric And Metabolic Surgery, Sao Paulo, Brazil. 9. Department of Surgery, Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI. 10. Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, University Côte d'Azur, Nice, France. 11. Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Las Condes, Santiago, Chile. 12. Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK. 13. Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, CA. 14. Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain. 15. Department of General Surgery, AZ Sint-Blasius Hospital, Dendermonde, Belgium. 16. Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach, Germany. 17. The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL. 18. Center for the treatment of Obesity and Diabetes - COD, Oswaldo Cruz German Hospital, Sao Paulo, Brazil. 19. Department of Visceral Surgery, Clarunis: St.Clara Hosptital and University Hospital Basel, Basel, Switzerland. 20. North Bristol Centre for Weight Loss Metabolic & Bariatric Surgery Southmead Hospital, Bristol, UK. 21. Department of Surgery, Vienna Medical University, Vienna, Austria. 22. The European School of Laparoscopic Surgery, St Pierre University Hospital, Brussels, Belgium. 23. Linköping University, Institute for Clinical and Experimental Medicine, Department of Surgery Vrinnevi, Norrköping, Sweden. 24. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Abstract
OBJECTIVE: To define "best possible" outcomes for bariatric surgery (BS)(Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]). BACKGROUND: Reference values for optimal surgical outcomes in well-defined low-risk bariatric patients have not been established so far. Consequently, outcome comparison across centers and over time is impeded by heterogeneity in case-mix. METHODS: Out of 39,424 elective BS performed in 19 high-volume academic centers from 3 continents between June 2012 and May 2017, we identified 4120 RYGB and 1457 SG low-risk cases defined by absence of previous abdominal surgery, concomitant procedures, diabetes mellitus, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, anticoagulation, BMI>50 kg/m and age>65 years. We chose clinically relevant endpoints covering the intra- and postoperative course. Complications were graded by severity using the comprehensive complication index. Benchmark values were defined as the 75th percentile of the participating centers' median values for respective quality indicators. RESULTS: Patients were mainly females (78%), aged 38±11 years, with a baseline BMI 40.8 ± 5.8 kg/m. Over 90 days, 7.2% of RYGB and 6.2% of SG patients presented at least 1 complication and no patients died (mortality in nonbenchmark cases: 0.06%). The most frequent reasons for readmission after 90-days following both procedures were symptomatic cholelithiasis and abdominal pain of unknown origin. Benchmark values for both RYGB and SG at 90-days postoperatively were 5.5% Clavien-Dindo grade ≥IIIa complication rate, 5.5% readmission rate, and comprehensive complication index ≤33.73 in the subgroup of patients presenting at least 1 grade ≥II complication. CONCLUSION: Benchmark cutoffs targeting perioperative outcomes in BS offer a new tool in surgical quality-metrics and may be implemented in quality-improvement cycle.ClinicalTrials.gov Identifier NCT03440138.
OBJECTIVE: To define "best possible" outcomes for bariatric surgery (BS)(Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]). BACKGROUND: Reference values for optimal surgical outcomes in well-defined low-risk bariatric patients have not been established so far. Consequently, outcome comparison across centers and over time is impeded by heterogeneity in case-mix. METHODS: Out of 39,424 elective BS performed in 19 high-volume academic centers from 3 continents between June 2012 and May 2017, we identified 4120 RYGB and 1457 SG low-risk cases defined by absence of previous abdominal surgery, concomitant procedures, diabetes mellitus, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, anticoagulation, BMI>50 kg/m and age>65 years. We chose clinically relevant endpoints covering the intra- and postoperative course. Complications were graded by severity using the comprehensive complication index. Benchmark values were defined as the 75th percentile of the participating centers' median values for respective quality indicators. RESULTS:Patients were mainly females (78%), aged 38±11 years, with a baseline BMI 40.8 ± 5.8 kg/m. Over 90 days, 7.2% of RYGB and 6.2% of SG patients presented at least 1 complication and no patients died (mortality in nonbenchmark cases: 0.06%). The most frequent reasons for readmission after 90-days following both procedures were symptomatic cholelithiasis and abdominal pain of unknown origin. Benchmark values for both RYGB and SG at 90-days postoperatively were 5.5% Clavien-Dindo grade ≥IIIa complication rate, 5.5% readmission rate, and comprehensive complication index ≤33.73 in the subgroup of patients presenting at least 1 grade ≥II complication. CONCLUSION: Benchmark cutoffs targeting perioperative outcomes in BS offer a new tool in surgical quality-metrics and may be implemented in quality-improvement cycle.ClinicalTrials.gov Identifier NCT03440138.
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