PMID- 34754518
OWN - NLM
STAT- MEDLINE
DCOM- 20220128
LR  - 20220128
IS  - 2090-0716 (Electronic)
IS  - 2090-0708 (Print)
IS  - 2090-0708 (Linking)
VI  - 2021
DP  - 2021
TI  - The Effect of Bariatric Surgery Volume on General Surgery Outcomes for Morbidly 
      Obese Patients.
PG  - 8945091
LID - 10.1155/2021/8945091 [doi]
LID - 8945091
AB  - INTRODUCTION: Bariatric surgery performed at high volume centers decreases length 
      of stay, cost, and morbidity and mortality. The effect of a high volume of 
      bariatric surgery procedures on outcomes may extend not just to bariatric surgery 
      but to any general surgical procedure in morbidly obese patients. We hypothesized 
      that patients with morbid obesity (body mass index >40 kg/m(2)) undergoing 
      common, nonbariatric general surgery would have decreased morbidity and mortality 
      at centers performing high volumes of bariatric surgery. METHODS: The 2016 
      National Inpatient Sample (NIS) was used to identify the number of laparoscopic 
      gastric bypass and sleeve gastrectomy performed at each hospital. Hospitals were 
      classified as high volume bariatric hospitals (HVBH) >/=10 reported cases (50 
      actual)/year or low volume bariatric hospitals (LVBH) <10 reported cases (50 
      actual)/year, as NIS reports a 20% sample of actual cases. Patients with morbid 
      obesity undergoing laparoscopic or open appendectomy, cholecystectomy, or ventral 
      hernia repair were included for analysis. Propensity scores were developed based 
      on available demographics, comorbidities, and hospital procedure volume. 
      Postoperative complications during the index hospital admission, determined by 
      ICD-10 code, were compared using inverse propensity weights. Differences were 
      considered significant with a p value of <0.05. RESULTS: The total number of 
      general surgery patient cases analyzed was 14,028 from 2,482 hospitals, 
      representing 70,140 admissions. The cohort of patients undergoing operations 
      treated at HVBH were younger (p=0.03) with higher rates of COPD (p=0.04). 
      Patients at LVBH had higher rates of nicotine dependence (p=0.0001) and 
      obstructive sleep apnea (p < 0.001). On propensity-weighted analysis adjusting 
      for preoperative comorbidities and hospital procedure volume, there were 
      significantly higher rates of multiple postprocedure complications at LVBH, 
      specifically, postprocedure respiratory failure for patients undergoing elective 
      laparoscopic cholecystectomy, elective ventral hernia repair with mesh and 
      appendectomy. CONCLUSION: Patients with morbid obesity may have an advantage in 
      having general surgery procedures at HVBH. HVBH may have a volume-outcomes 
      relationship where the hospital and staff familiarity with the management 
      principles required to minimize the postoperative risk associated with morbid 
      obesity and improve patient outcomes.
CI  - Copyright (c) 2021 Katheryn Hope Wilkinson et al.
FAU - Wilkinson, Katheryn Hope
AU  - Wilkinson KH
AUID- ORCID: 0000-0001-8676-2847
AD  - Department of Surgery, Medical College of Wisconsin, 8900 W Doyne Avenue, 
      Milwaukee, WI 53226, USA.
FAU - Wu, Ruizhe
AU  - Wu R
AD  - Division of Biostatistics, Institute for Health and Equity, Medical College of 
      Wisconsin, 8900 W Doyne Avenue, Milwaukee, WI 53226, USA.
FAU - Szabo, Aniko
AU  - Szabo A
AD  - Division of Biostatistics, Institute for Health and Equity, Medical College of 
      Wisconsin, 8900 W Doyne Avenue, Milwaukee, WI 53226, USA.
FAU - Higgins, Rana
AU  - Higgins R
AD  - Department of Surgery, Medical College of Wisconsin, 8900 W Doyne Avenue, 
      Milwaukee, WI 53226, USA.
FAU - Gould, Jon
AU  - Gould J
AD  - Department of Surgery, Medical College of Wisconsin, 8900 W Doyne Avenue, 
      Milwaukee, WI 53226, USA.
FAU - Kindel, Tammy
AU  - Kindel T
AUID- ORCID: 0000-0001-7489-7189
AD  - Department of Surgery, Medical College of Wisconsin, 8900 W Doyne Avenue, 
      Milwaukee, WI 53226, USA.
LA  - eng
PT  - Journal Article
DEP - 20211031
PL  - United States
TA  - J Obes
JT  - Journal of obesity
JID - 101526295
SB  - IM
MH  - *Bariatric Surgery
MH  - Gastrectomy
MH  - *Gastric Bypass
MH  - Humans
MH  - *Laparoscopy
MH  - *Obesity, Morbid/surgery
MH  - Postoperative Complications
MH  - Retrospective Studies
MH  - Treatment Outcome
PMC - PMC8572633
COIS- The authors declare that they have no conflicts of interest.
EDAT- 2021/11/11 06:00
MHDA- 2022/01/29 06:00
PMCR- 2021/10/31
CRDT- 2021/11/10 06:42
PHST- 2021/09/08 00:00 [received]
PHST- 2021/10/06 00:00 [accepted]
PHST- 2021/11/10 06:42 [entrez]
PHST- 2021/11/11 06:00 [pubmed]
PHST- 2022/01/29 06:00 [medline]
PHST- 2021/10/31 00:00 [pmc-release]
AID - 10.1155/2021/8945091 [doi]
PST - epublish
SO  - J Obes. 2021 Oct 31;2021:8945091. doi: 10.1155/2021/8945091. eCollection 2021.