The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: The first report from the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP)

Elizabeth R. Berger, Ronald H. Clements, John M. Morton, Kristopher M. Huffman, Bruce Wolfe, Ninh T. Nguyen, Clifford Y. Ko, Matthew M. Hutter

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Objective: Questions remain regarding best surgical techniques to use for a laparoscopic sleeve gastrectomy (LSG) including the use of staple line reinforcement (SLR), bougie size (BS), and distance from the pylorus (DP) where the staple line is initiated. Our objectives were to assess the impact of these techniques on 30-day outcomes and to evaluate the impact of these techniques on weight loss and comorbidities at 1 year. Methods: Using the MBSAQIP data registry, univariate analyses and hierarchical logistical regression models were developed to analyze outcomes for techniques of LSG at patient and surgeon-level. Results: A total of 189,477 LSG operations were performed by 1634 surgeons at 720 centers from 2012 to 2014. Eighty percent of surgeons used SLR, 20% did not. SLR cases were associated with higher leak rates (0.96% vs 0.65%, odds ratio [OR] 1.20 95% confidence interval [CI] 1.00-1.43) and lower bleed rates (0.75% vs 1.00%, OR 0.74 95% CI 0.63-0.86) compared to no SLR at patient level. At the surgeon level, leak rates remained significant, but bleeding events became nonsignificant. BS ≥38 was associated with significantly lower leak rates compared to BS<38 at patient and surgeon level (patient level: 0.80% vs 0.96%, OR 0.72, 95% CI 0.62-0.94; surgeon level: 0.84% vs 0.95%, OR 0.90, 95% CI 0.80-0.99). BS ≥40 was associated with increased weight loss. DP had no impact on leaks or bleeds but showed an increase in weight loss with increasing DP. Conclusion: LSG is a safe procedure with a low morbidity rate. SLR is associated with increased leak rates. A surgeon should consider risks, benefits, and costs of these surgical techniques when performing a LSG and selectively utilize those that, in their hands, minimize morbidity while maximizing clinical effectiveness.

Original languageEnglish (US)
Pages (from-to)464-471
Number of pages8
JournalAnnals of Surgery
Volume264
Issue number3
DOIs
StatePublished - Sep 1 2016

Fingerprint

Bariatric Surgery
Accreditation
Gastrectomy
Quality Improvement
Pylorus
Odds Ratio
Confidence Intervals
Weight Loss
Morbidity
Surgeons
Cost-Benefit Analysis
Registries
Comorbidity
Hand
Hemorrhage

Keywords

  • Bariatric surgery
  • Laparoscopic sleeve gastrectomy
  • Metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP)
  • Process measures

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies : The first report from the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP). / Berger, Elizabeth R.; Clements, Ronald H.; Morton, John M.; Huffman, Kristopher M.; Wolfe, Bruce; Nguyen, Ninh T.; Ko, Clifford Y.; Hutter, Matthew M.

In: Annals of Surgery, Vol. 264, No. 3, 01.09.2016, p. 464-471.

Research output: Contribution to journalArticle

Berger, Elizabeth R. ; Clements, Ronald H. ; Morton, John M. ; Huffman, Kristopher M. ; Wolfe, Bruce ; Nguyen, Ninh T. ; Ko, Clifford Y. ; Hutter, Matthew M. / The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies : The first report from the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP). In: Annals of Surgery. 2016 ; Vol. 264, No. 3. pp. 464-471.
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abstract = "Objective: Questions remain regarding best surgical techniques to use for a laparoscopic sleeve gastrectomy (LSG) including the use of staple line reinforcement (SLR), bougie size (BS), and distance from the pylorus (DP) where the staple line is initiated. Our objectives were to assess the impact of these techniques on 30-day outcomes and to evaluate the impact of these techniques on weight loss and comorbidities at 1 year. Methods: Using the MBSAQIP data registry, univariate analyses and hierarchical logistical regression models were developed to analyze outcomes for techniques of LSG at patient and surgeon-level. Results: A total of 189,477 LSG operations were performed by 1634 surgeons at 720 centers from 2012 to 2014. Eighty percent of surgeons used SLR, 20{\%} did not. SLR cases were associated with higher leak rates (0.96{\%} vs 0.65{\%}, odds ratio [OR] 1.20 95{\%} confidence interval [CI] 1.00-1.43) and lower bleed rates (0.75{\%} vs 1.00{\%}, OR 0.74 95{\%} CI 0.63-0.86) compared to no SLR at patient level. At the surgeon level, leak rates remained significant, but bleeding events became nonsignificant. BS ≥38 was associated with significantly lower leak rates compared to BS<38 at patient and surgeon level (patient level: 0.80{\%} vs 0.96{\%}, OR 0.72, 95{\%} CI 0.62-0.94; surgeon level: 0.84{\%} vs 0.95{\%}, OR 0.90, 95{\%} CI 0.80-0.99). BS ≥40 was associated with increased weight loss. DP had no impact on leaks or bleeds but showed an increase in weight loss with increasing DP. Conclusion: LSG is a safe procedure with a low morbidity rate. SLR is associated with increased leak rates. A surgeon should consider risks, benefits, and costs of these surgical techniques when performing a LSG and selectively utilize those that, in their hands, minimize morbidity while maximizing clinical effectiveness.",
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AU - Berger, Elizabeth R.

AU - Clements, Ronald H.

AU - Morton, John M.

AU - Huffman, Kristopher M.

AU - Wolfe, Bruce

AU - Nguyen, Ninh T.

AU - Ko, Clifford Y.

AU - Hutter, Matthew M.

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N2 - Objective: Questions remain regarding best surgical techniques to use for a laparoscopic sleeve gastrectomy (LSG) including the use of staple line reinforcement (SLR), bougie size (BS), and distance from the pylorus (DP) where the staple line is initiated. Our objectives were to assess the impact of these techniques on 30-day outcomes and to evaluate the impact of these techniques on weight loss and comorbidities at 1 year. Methods: Using the MBSAQIP data registry, univariate analyses and hierarchical logistical regression models were developed to analyze outcomes for techniques of LSG at patient and surgeon-level. Results: A total of 189,477 LSG operations were performed by 1634 surgeons at 720 centers from 2012 to 2014. Eighty percent of surgeons used SLR, 20% did not. SLR cases were associated with higher leak rates (0.96% vs 0.65%, odds ratio [OR] 1.20 95% confidence interval [CI] 1.00-1.43) and lower bleed rates (0.75% vs 1.00%, OR 0.74 95% CI 0.63-0.86) compared to no SLR at patient level. At the surgeon level, leak rates remained significant, but bleeding events became nonsignificant. BS ≥38 was associated with significantly lower leak rates compared to BS<38 at patient and surgeon level (patient level: 0.80% vs 0.96%, OR 0.72, 95% CI 0.62-0.94; surgeon level: 0.84% vs 0.95%, OR 0.90, 95% CI 0.80-0.99). BS ≥40 was associated with increased weight loss. DP had no impact on leaks or bleeds but showed an increase in weight loss with increasing DP. Conclusion: LSG is a safe procedure with a low morbidity rate. SLR is associated with increased leak rates. A surgeon should consider risks, benefits, and costs of these surgical techniques when performing a LSG and selectively utilize those that, in their hands, minimize morbidity while maximizing clinical effectiveness.

AB - Objective: Questions remain regarding best surgical techniques to use for a laparoscopic sleeve gastrectomy (LSG) including the use of staple line reinforcement (SLR), bougie size (BS), and distance from the pylorus (DP) where the staple line is initiated. Our objectives were to assess the impact of these techniques on 30-day outcomes and to evaluate the impact of these techniques on weight loss and comorbidities at 1 year. Methods: Using the MBSAQIP data registry, univariate analyses and hierarchical logistical regression models were developed to analyze outcomes for techniques of LSG at patient and surgeon-level. Results: A total of 189,477 LSG operations were performed by 1634 surgeons at 720 centers from 2012 to 2014. Eighty percent of surgeons used SLR, 20% did not. SLR cases were associated with higher leak rates (0.96% vs 0.65%, odds ratio [OR] 1.20 95% confidence interval [CI] 1.00-1.43) and lower bleed rates (0.75% vs 1.00%, OR 0.74 95% CI 0.63-0.86) compared to no SLR at patient level. At the surgeon level, leak rates remained significant, but bleeding events became nonsignificant. BS ≥38 was associated with significantly lower leak rates compared to BS<38 at patient and surgeon level (patient level: 0.80% vs 0.96%, OR 0.72, 95% CI 0.62-0.94; surgeon level: 0.84% vs 0.95%, OR 0.90, 95% CI 0.80-0.99). BS ≥40 was associated with increased weight loss. DP had no impact on leaks or bleeds but showed an increase in weight loss with increasing DP. Conclusion: LSG is a safe procedure with a low morbidity rate. SLR is associated with increased leak rates. A surgeon should consider risks, benefits, and costs of these surgical techniques when performing a LSG and selectively utilize those that, in their hands, minimize morbidity while maximizing clinical effectiveness.

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KW - Process measures

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