Low hospital complication rates With bariatric surgery

This week's issue of the Journal of the American College of Surgeons reports on hospital complication rates with bariatric surgery in the USA.

Despite the growing popularity of bariatric surgery, there remain concerns about perioperative safety and variation in outcomes across hospitals.

Dr Nancy Birkmeyer and colleagues from Michigan, USA assessed complication rates of different bariatric procedures and variability in rates of serious complications across hospitals and according to procedure volume and center of excellence status.

The researchers evaluated 25 hospitals and 62 surgeons statewide, the Michigan Bariatric Surgery Collaborative (MBSC) administers an externally audited, prospective clinical registry.

7% of patients experienced perioperative complications

Journal of the American Medical Association

The research team evaluated short-term morbidity in 15 275 Michigan patients undergoing 1 of 3 common bariatric procedures between 2006 and 2009.

The researchers used multilevel regression models to assess variation in risk-adjusted complication rates across hospitals and the effects of procedure volume and COE designation (by the American College of Surgeons or American Society for Metabolic and Bariatric Surgery) status.

The team's main outcome measure was complications occurring within 30 days of surgery.

Overall, 7% of patients experienced perioperative complications, most of which were wound problems and other minor complications.

Serious complications were most common after gastric bypass, followed by sleeve gastrectomy, and laparoscopic adjustable gastric band procedures.

The research team found that mortality occurred in 0.04% of laparoscopic adjustable gastric band, 0 sleeve gastrectomy, and 0.14% of the gastric bypass patients.

After adjustment for patient characteristics and procedure mix, rates of serious complications varied from about 2% to 4% across hospitals.

Average annual procedure volume was inversely associated with rates of serious complications at both the hospital level, and surgeon level.

The researchers observed that adjusted rates of serious complications were similar in center of excellence and non-center of excellence hospitals.

Dr Birkmeyer's team concludes, "The frequency of serious complications among patients undergoing bariatric surgery in Michigan was relatively low."

"Rates of serious complications are inversely associated with hospital and surgeon procedure volume, but unrelated to center of excellence accreditation by professional organizations."