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Result of a National Audit of Bariatric Surgery Performed at Academic Centers
A 2004 University HealthSystem Consortium Benchmarking Project
Ninh T. Nguyen, MD;
Michael Silver, MD;
Malcolm Robinson, MD;
Bradley Needleman, MD;
Guilford Hartley, MD;
Robert Cooney, MD;
Robert Catalano, MD;
Jackie Dostal, MBA;
Danny Sama, BS;
Jeanne Blankenship, MS;
Kathryn Burg, MSN;
Edward Stemmer, MD;
Samuel E. Wilson, MD
Arch Surg. 2006;141:445-450.
Hypothesis Bariatric surgery performed at US academic centers is safe and associated with low mortality.
Design Multi-institutional consecutive cohort study.
Setting Academic medical centers.
Patients and Interventions We audited the medical records from 40 consecutive bariatric surgery cases performed between October 1, 2003, and March 31, 2004, at each of the 29 institutions participating in the University HealthSystem Consortium Bariatric Surgery Benchmarking Project. All medical records that met inclusion criteria (patient age, >17 and <65 years; and body mass index [calculated as weight in kilograms divided by the square of height in meters], 35-70) and exclusion criteria (previous bariatric surgery) were reviewed and data were collected on a standardized form.
Main Outcome Measures Demographic data, operative time, blood loss, transfusion requirement, complications, readmission, reoperation, and in-hospital and 30-day mortality.
Results Data from 1144 bariatric surgery cases were reviewed from 29 University HealthSystem Consortium institutions. The specific bariatric procedures included gastric bypass (91.7%), gastroplasty or gastric banding (8.2%), and biliopancreatic diversion (0.1%). For gastric bypass procedures (n = 1049), the mean patient age was 43 years and mean body mass index was 49; 76% of procedures were performed laparoscopically, with a conversion rate of 2.2%; the overall complication rate was 16%, with an anastomotic leakage rate of 1.6%; the 30-day readmission rate was 6.6%; and the 30-day mortality rate was 0.4%. For restrictive procedures (n = 94), the mean patient age was 45 years and mean body mass index was 45; 92% of procedures were performed laparoscopically with no conversion; the overall complication rate was 3.2%; the 30-day readmission rate was 4.3%; and the 30-day mortality rate was 0%.
Conclusions Within the context of the 2004 University HealthSystem Consortium Bariatric Surgery Benchmarking Project, the risk for death within 30 days after bariatric surgery at academic centers is less than 1%. In addition, the practice of bariatric surgery at these centers has shifted from open surgery to predominately laparoscopic surgery. These quality-controlled outcome data can be used as a benchmark for the practice of bariatric surgery at most US hospitals.
Author Affiliations: Departments of Surgery, University of California–Irvine Medical Center, Orange (Drs Nguyen, Stemmer, and Wilson); Brigham and Women's Hospital, Boston, Mass (Dr Robinson); The Ohio State University Medical Center, Columbus (Dr Needleman); Penn State University Milton S. Hershey Medical Center, Hershey (Dr Cooney); Albany Medical Center, Albany, NY (Dr Catalano); University of California–Davis Medical Center, Sacramento (Ms Blankenship); and University of Pennsylvania Health System, Philadelphia (Ms Burg); and Departments of Medicine, Rush University Medical Center, Chicago, Ill (Dr Silver); Hennepin County Medical Center, Minneapolis, Minn (Dr Hartley); and University HealthSystem Consortium, Oak Brook, Ill (Ms Dostal and Mr Sama).
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