The procedure volume of the surgeon and facility performing bariatric surgery has a greater impact on the risk of serious complications than whether the facility is accredited as a bariatric "center of excellence," according to a study of bariatric outcomes in Michigan hospitals.

In the study of 25 hospitals and 62 surgeons performing 3 common bariatric procedures — gastric bypass, sleeve gastrectomy and laparoscopic adjustable gastric band — between 2006 and 2009, a little more than 7% of patients experienced perioperative complications, most of which were minor.

When adjusted for patient characteristics and procedure mix, the overall rate of serious complications varied from 1.6% to 3.5%. Gastric bypass had the highest risk of serious complications (3.6%), followed by sleeve gastrectomy (2.2%) and laparoscopic adjustable gastric band (0.9%). Surgical site infection was the most common type of complication, affecting 3.2% of the 15,275 patients studied.

Researchers led by Nancy J.O. Birkmeyer, PhD, of the University of Michigan, examined the relationship of procedure volume (both by surgeon and hospital) and center of excellence (COE) accreditation to the rate of complications. They found that procedure volume had an inverse association with complication risk. "Serious complication rates were about twice as high (4%) for low-volume surgeons at low-volume hospitals than for high-volume surgeons at high-volume hospitals (1.9%)," write the authors.

However, the rate of serious complications was not significantly different at COE hospitals (2.7%) than it was at non-COE institutions (2%). A 2009 Texas study similarly found no connection between COE designation and better bariatric outcomes.

While they acknowledge that their data is limited to Michigan hospitals, the authors conclude that their findings, published in the Journal of the American Medical Association, "may serve as useful safety performance benchmarks for hospitals performing bariatric surgery."

Irene Tsikitas

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