Hospital Complication Rates With Bariatric Surgery in Michigan
Authors: Nancy J. O. Birkmeyer, Justin B. Dimick, David Share, Abdelkader Hawasli, Wayne J. English, Jeffrey Genaw, Jonathan F. Finks, Arthur M. Carlin, John D. Birkmeyer, for the Michigan Bariatric Surgery Collaborative
Journal: JAMA (2010)

INCREASINGover the last decade, 1 bariatric surgery has become the second most common abdominal operation in the United States.Despite trends toward declining mortality rates, 2 payers and patient advocacy groups remain concerned about the safety of bariatric surgery and uneven quality across hospitals.In response, 2 major professional organizations-the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery-have implemented programs for accrediting hospitals as centers of excellence (COE) in bariatric surgery.Standards for COE accreditation vary somewhat between the programs, but they generally include minimum procedure volume standards, availability of specific protocols and resources for managing morbidly obese patients, and submission of outcomes data to a central registry.Context Despite the growing popularity of bariatric surgery, there remain concerns about perioperative safety and variation in outcomes across hospitals.Objective To assess complication rates of different bariatric procedures and variability in rates of serious complications across hospitals and according to procedure volume and center of excellence (COE) status.Design, Setting, and Patients Involving 25 hospitals and 62 surgeons statewide, the Michigan Bariatric Surgery Collaborative (MBSC) administers an externally audited, prospective clinical registry.We evaluated short-term morbidity in 15 275 Michigan patients undergoing 1 of 3 common bariatric procedures between 2006 and 2009.We 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. Main Outcome Measure Complications occurring within 30 days of surgery.Results Overall, 7.3% of patients experienced perioperative complications, most of which were wound problems and other minor complications.Serious complications were most common after gastric bypass (3.6%; 95% confidence interval [CI], 3.2%-4.0%),followed by sleeve gastrectomy (2.2%; 95% CI, 1.2%-3.2%),and laparoscopic adjustable gastric band (0.9%; 95% CI, 0.6%-1.1%)procedures (PϽ.001).Mortality occurred in 0.04% (95% CI, 0.001%-0.13%) of laparoscopic adjustable gastric band, 0 sleeve gastrectomy, and 0.14% (95% CI, 0.08%-0.25%) of the gastric bypass patients.After adjustment for patient characteristics and procedure mix, rates of serious complications varied from 1.6% (95% CI, 1.3-2.0) to 3.5% (95% CI, 2.4-5.0)(risk difference, 1.9; 95% CI, 0.08-3.7)across hospitals.Average annual procedure volume was inversely associated with rates of serious complications at both the hospital level (Ͻ150 cases, 4.1%; 95% CI, 3.0%-5.1%;150-299 cases, 2.7%; 95% CI, 2.2-3.2; and Ն300 cases, 2.3%; 95% CI, 2.0%-2.6%;P=.003) and surgeon level (Ͻ100 cases, 3.8%; 95% CI, 3.2%-4.5%;100-249 cases, 2.4%; 95% CI, 2.1%-2.8%;Ն250cases, 1.9%; 95% CI, 1.4%-2.3%;P=.001).Adjusted rates of serious complications were similar in COE and non-COE hospitals (COE, 2.7%; 95% CI, 2.5%-3.1%;non-COE, 2.0%; 95% CI, 1.5%-2.4%;P=.41). ConclusionsThe 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 COE accreditation by professional organizations.