High-Volume Surgical Caseload More Important than Center of Excellence Status in Surgical Complication Rates

Thursday, 05 August 2010 15:09

A new study published in the July 28 issue of the Journal of the American Medical Association reports that complication rates of bariatric surgery are relatively low, and hospitals that perform the highest number of weight-loss surgeries experience the lowest complication rates.

Researchers from the University of Michigan examined data from more than 15,000 patients who underwent gastric bypass, adjustable gastric banding, or vertical sleeve gastrectomy between 2006 and 2009. The surgeries were performed by 62 surgeons at 25 different hospitals in the state of Michigan.

Surgical complications were relatively low, with only 7.3 percent of patients experiencing  one or more issues, which were mostly wound problems and other minor complications. Among gastric bypass patients, 3.6 percent experienced complications after surgery, while 2.2 percent of sleeve gastrectomy patients and only 0.9 percent of gastric banding patients experienced some sort of complication.

The most common type of complication was infection at the surgical site, which was experienced by 2. 5 percent of gastric banding patients. Two patients undergoing gastric banding experienced fatal complications, as compared to 13 gastric bypass patients.

Rates of complications varied among hospitals, from 1.6 percent to 3.5 percent.  The study indicated that rates of serious complications were roughly twice as high in low-volume hospitals. High-volume hospitals, which were defined as those that performed more than 300 bariatric surgeries per year, experienced a 1.9 percent complication rate. The rate of complications at low-volume hospitals was 4.3 percent.

Whether hospitals were designated as a bariatric Center of Excellence had no bearing on complication rates. In fact, complication rates at Bariatric Centers of Excellence were 2.7 percent, compared to 2 percent at other hospitals.

"Patients should look for a high volume surgeon and hospital when considering where to have bariatric surgery," says Nancy Birkmeyer, Ph.D., lead author of the study and senior scientist at the University of Michigan's Center for Healthcare Outcomes and Policy.

Birkmeyer notes that Bariatric Surgery Center of Excellence status may have little bearing on surgical complication rates because accreditation is based on self-reported data that is not always audited. Centers of Excellence may have specialized resources for taking care of bariatric patients, such as larger beds and imaging equipments, but hospitals are required to perform only 125 bariatric surgeries in the last 12 months to qualify for BSCOE status.

According to the University of Michigan, bariatric surgery rates have risen from 16,000 in the early 1990s to more than 180,000 in 2005. Weight-loss surgery has become the second most common abdominal surgery in the US, after appendectomy.

Application for BSCOE status is voluntary. Study authors report that given the highly competitive marketplace for weight-loss surgery, accreditation may be attractive to hospitals and surgery centers wishing to demonstrate and improve their quality. But according to Birkmeyer, "collaborative quality improvement may be more effective than COE programs."

When choosing your bariatric surgeon, ask about the number of surgeries your doctor has performed, as well as the number of surgeries completed at the hospital or surgical center where he or she operates. According to Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, frequency and repetition are keys to the best surgical outcomes.