Between 1991 and 2000, the prevalence of @entity28 increased 65 per cent. As a result, increasing research is being directed at gastric bypass (GB) surgery, an operation that appears to achieve long-term weight reduction. Despite the rapid proliferation of this surgery, the quality of care at a population level is largely unknown. This study examines longitudinal trends in quality and identifies significant predictors of adverse outcomes. Using the California inpatient discharge database, all GB operations from 1996 to 2000 were identified. Demographic, comorbidity, complication, and volume data were obtained. Complications were defined as life-threatening cardiac, respiratory, or medical ( @entity177 or shock) events. Comorbidity was graded on a modified Charlson score. Annual hospital volume was categorized into four groups: < 50, 50-99, 100-199, and 200+ cases. Based on these data, we calculated longitudinal trends in complication rate and performed logistic regression to identify predictors of complications. A total of 16,232 @entity1 were included. The average age was 41 years; 84 per cent were female, and 83.5 per cent were white. The complication rate was 10.4 per cent. Between 1996 and 2000, rates of @entity299 decreased while rates of medical complications remained unchanged. Complications were more likely in @entity1 [odd ratio (OR) = 1.69 compared to @entity1 ] and in @entity1 with comorbidities (OR = 1.60 for each additional comorbid disease). Furthermore, when examining the effect of volume, @entity1 at very low (< 50) and low (50-99) volume hospitals were much more likely to have complications (OR = 2.72 and 2.70, respectively) compared to @entity1 at high-volume hospitals (200+), even after controlling for differences in case-mix. The quality of care for @entity28 surgery has improved between 1996 and 2000. Despite operating on @entity1 with more comorbidity, rates of @entity299 have decreased. Furthermore, this study identifies three independent predictors of complications: gender, comorbidity, and hospital volume. These findings are important initial steps toward improving quality in @entity28 surgery.

Characterizing the performance and outcomes of XXXX surgery in California.

@entity177 :: ('MESH:D051437', 'Disease') :: ['renal failure'] @entity1 :: ('9606', 'Species') :: ['women', 'patients', 'men'] @entity28 :: ('MESH:D009765', 'Disease') :: ['obesity'] @entity299 :: ('MESH:D006331', 'Disease') :: ['cardiac and respiratory complications']
@entity28 :: (MESH:D009765,Disease) :: ['obesity']
