TY - JOUR
T1 - Relationship between surgeon volume and adverse outcomes after RYGB in Longitudinal Assessment of Bariatric Surgery (LABS) study
AU - Smith, Mark D.
AU - Patterson, Emma
AU - Wahed, Abdus S.
AU - Belle, Steven H.
AU - Bessler, Marc
AU - Courcoulas, Anita P.
AU - Flum, David
AU - Halpin, Valerie
AU - Mitchell, James E.
AU - Pomp, Alfons
AU - Pories, Walter J.
AU - Wolfe, Bruce
N1 - Funding Information:
S. Belle, none; M. Bessler, none; A. Courcoulas, none; D. Flum, American College of Surgeons Bariatric Centers (Speakers Bureau) , Sanofi-Aventis (Educational or Research Grant Recipient); V. Halpin, none; J. Mitchell, none; E. Patterson, consultant to Allergan Health, a company that might have a commercial interest in the results of this Research—this potential conflict of interest has been reviewed and managed by Oregon Health and Science University; A. Pomp, none; W. Pories, research grants from Johnson & Johnson and GlaxoSmith Kline ; M. Smith, none; A. Wahed, none; B. Wolfe, American College of Surgeons Bariatric Centers (Speakers Bureau), Enteromedics (Consultant), Surgical Review Corporation (Speakers Bureau).
Funding Information:
The LABS personnel contributing to the present study included Paul D. Berk, M.D., Marc Bessler, M.D., Amna Daud, M.D., M.P.H, Dan Davis, D.O., W. Barry Inabnet, M.D., Munira Kassam, BS, Beth Schrope, M.D., Ph.D., Columbia University Medical Center, New York, NY; Greg Dakin, M.D., Faith Ebel, MS, MPH, Michel Gagner, M.D., Jane Hsieh, BS, Alfons Pomp, M.D., Gladys Strain, Ph.D., Cornell University Medical Center, New York, NY; Rita Bowden, R.N., William Chapman, M.D., F.A.C.S., Lynis Dohm, Ph.D., John Pender M.D., Walter Pories, M.D., F.A.C.S., East Carolina Medical Center, Greenville, NC; Michael Howell, M.D., Luis Garcia, M.D., Michelle Kuznia, B.A., Kathy Lancaster, B.A., James E. Mitchell, M.D., Tim Monson, M.D., Jamie Roth, B.A. Neuropsychiatric Research Institute, Fargo, ND; Clifford Deveney, M.D., Katherine Elder, Ph.D., Stefanie Greene, MS, Robyn Lee, BS, Jonathan Purnell, M.D., Robert O'Rourke, M.D., Chad Sorenson, BS, Bruce M. Wolfe, M.D., Zachary Walker, BS, Oregon Health and Science University; Valerie Halpin, M.D., Jay Jan, M.D., Crystal Jones, BS, Emma Patterson, M.D., Milena Petrovic, MS, Cameron Rogers, BS, Legacy Good Samaritan Hospital, Portland, OR; Iselin Austrheim-Smith, C.C.R.P., Laura Machado, M.D., Sacramento Bariatric Medical Associates, Sacramento, CA; Anita P. Courcoulas, M.D., M.P.H., F.A.C.S., George Eid, M.D., William Gourash, M.S.N., C.R.N.P., Lewis H. Kuller, M.D., Dr.P.H., Carol A. McCloskey, M.D., Ramesh Ramanathan, M.D., University of Pittsburgh Medical Center, Pittsburgh, PA; David E. Cummings, M.D., E. Patchen Dellinger, M.D., David R. Flum, M.D., M.P.H., Kris Kowdley, M.D., Juanita Law, BS, Kelly Lucas, B.A., Brant Oelschlager, M.D., Andrew Wright, M.D., University of Washington, Seattle, WA; Lily Chang, M.D., Stephen Geary, R.N., Jeffrey Hunter, M.D., Ravi Moonka, M.D., Olivia A. Seibenick, C.C.R.C., Richard Thirlby, M.D., Virginia Mason Medical Center, Seattle, WA; Steven H. Belle, Ph.D., M.Sc.Hyg., Michelle Caporali, B.S., Wendy C. King, Ph.D., Kevin Kip, Ph.D., Kira Leishear, B.S., Laurie Koozer, B.A., Debbie Martin, B.A., Rocco Mercurio, M.B.A., Faith Selzer, Ph.D., Abdus Wahed, Ph.D., Data Coordinating Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Mary Evans, Ph.D., Mary Horlick, M.D., Carolyn W. Miles, Ph.D., Myrlene A. Staten, M.D., Susan Z. Yanovski, M.D., National Institute of Diabetes and Digestive and Kidney Diseases; David E. Kleiner, M.D., Ph.D., National Cancer Institute, Bethesda, MD.
PY - 2010/3/4
Y1 - 2010/3/4
N2 - Background: Bariatric surgery is technically demanding surgery performed on high-risk patients. Previous studies using administrative databases have shown a relationship between surgeon volume and patient outcome after Roux-en-Y gastric bypass (RYGB). We examined the relationship between surgeons' annual RYGB volumes and 30-day patient outcomes at 10 centers within the United States. Methods: The Longitudinal Assessment of Bariatric Surgery (LABS)-1 is a prospective study examining the 30-day adverse outcomes after bariatric surgery. The outcomes after RYGB were adjusted by procedure type (open versus laparoscopic), functional status, body mass index, history of deep vein thrombosis, pulmonary embolism, and obstructive sleep apnea. The data were examined to determine the nature and strength of the association between surgeon volume and patients' short-term (30-day) adverse outcomes after RYGB. Results: The analysis included 3410 initial RYGB operations performed by 31 surgeons, 15 of whom averaged <50 cases annually. The crude composite adverse outcome (i.e., death, deep vein thrombosis, pulmonary embolism, reintervention or nondischarge at day 30) incidence was 5.2%. After risk adjustment, a greater surgeon RYGB volume was associated with lower composite event rates, with a continuous relationship (i.e., varying cutpoints differentiated the composite event rates), such that for each 10-case/yr increase in volume, the risk of a composite event decreased by 10%. Conclusion: In the LABS, the patient's risk of an adverse outcome after RYGB decreased significantly with the increase in surgeon RYGB volume (cases performed annually).
AB - Background: Bariatric surgery is technically demanding surgery performed on high-risk patients. Previous studies using administrative databases have shown a relationship between surgeon volume and patient outcome after Roux-en-Y gastric bypass (RYGB). We examined the relationship between surgeons' annual RYGB volumes and 30-day patient outcomes at 10 centers within the United States. Methods: The Longitudinal Assessment of Bariatric Surgery (LABS)-1 is a prospective study examining the 30-day adverse outcomes after bariatric surgery. The outcomes after RYGB were adjusted by procedure type (open versus laparoscopic), functional status, body mass index, history of deep vein thrombosis, pulmonary embolism, and obstructive sleep apnea. The data were examined to determine the nature and strength of the association between surgeon volume and patients' short-term (30-day) adverse outcomes after RYGB. Results: The analysis included 3410 initial RYGB operations performed by 31 surgeons, 15 of whom averaged <50 cases annually. The crude composite adverse outcome (i.e., death, deep vein thrombosis, pulmonary embolism, reintervention or nondischarge at day 30) incidence was 5.2%. After risk adjustment, a greater surgeon RYGB volume was associated with lower composite event rates, with a continuous relationship (i.e., varying cutpoints differentiated the composite event rates), such that for each 10-case/yr increase in volume, the risk of a composite event decreased by 10%. Conclusion: In the LABS, the patient's risk of an adverse outcome after RYGB decreased significantly with the increase in surgeon RYGB volume (cases performed annually).
KW - Complications
KW - LABS
KW - Longitudinal Assessment of Bariatric Surgery
KW - RYGB
KW - Roux-en-Y gastric bypass
KW - Volume-outcome
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U2 - 10.1016/j.soard.2009.09.009
DO - 10.1016/j.soard.2009.09.009
M3 - Article
C2 - 19969507
AN - SCOPUS:77950022538
VL - 6
SP - 118
EP - 125
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
SN - 1550-7289
IS - 2
ER -