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Fewer Complications Despite Greater Bariatric Frequency

Wed, 07/28/2010 - 6:00am

An examination of 15,000 bariatric surgery patients in Michigan finds that the frequency of serious complications is relatively low, and is inversely associated with hospital and surgeon procedural volume, according to a study published in JAMA.

With rates of bariatric surgery increasing over the last decade, it has become the second most common abdominal operation in the United States. “Despite trends toward declining mortality rates, payers and patient advocacy groups remain concerned about the safety of bariatric surgery and uneven quality across hospitals,” the authors write.

Nancy J. O. Birkmeyer, Ph.D., of the University of Michigan, and colleagues studied perioperative outcomes of bariatric surgery in Michigan, including comparing complication rates by procedure and among hospitals and the relationship between procedure volume, hospital safety, and centers of excellence accreditation. The study involved 25 hospitals, 62 surgeons statewide and data from a clinical outcomes registry.

The researchers found that, overall, 7.3 percent of patients experienced one or more perioperative complications, most of which were wound problems and other minor complications. Serious complications were most common after gastric bypass (3.6 percent), followed by sleeve gastrectomy (2.2 percent), and laparoscopic adjustable gastric band (0.9 percent) procedures. After adjustment for patient characteristics and procedure mix, rates of serious complications varied from 1.6 percent to 3.5 percent across hospitals.

Infection was the most frequent type of surgical site complication (3.2 percent) and was most common among patients undergoing gastric bypass (4.4 percent) and sleeve gastrectomy (2.5 percent) procedures. Fatal complications occurred in two patients receiving laparoscopic adjustable gastric band (0.04 percent), zero patients receiving sleeve gastrectomy, and 13 patients receiving gastric bypass (0.14 percent).

Risk of serious complications was inversely associated with average annual bariatric procedure volume. The researchers note that the findings of this study may not be generalizable outside of the state of Michigan, but “believe that the results reported in this study represent the outcomes of bariatric surgery that are possible, but not necessarily those that are typical in community settings.”

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