Effect of Surgeon Volume on Sleeve Gastrectomy Outcomes.

BACKGROUND: Prior studies have shown a relationship between surgeon volume and patient outcomes in Roux-en-Y gastric bypass (RYGB) patients. Laparoscopic sleeve gastrectomy (SG) is now the most common bariatric procedure, but there is a little data on surgeon volume and outcomes after SG. We examined the relationship between annual surgeon bariatric volume and 30-day complication rate after SG.

METHODS: The Bariatric Outcomes Longitudinal Database for 2011 was used for this study. Using 50 annual cases as a cutoff point, surgeons were classified as low (LV-SG) or high volume SG (HV-SG) and low (LV-RYGB) or high volume RYGB (HV-RYGB) providers. Multivariable logistic regression models were used to examine the effect of surgeon volume on 30-day readmissions, reoperations, and complications following SG while controlling for patient demographics and comorbidities.

RESULTS: We identified 16,547 SG patients. After controlling for baseline characteristics, HV-SG surgeons had lower rates of 30-day complications (OR 0.80, 95 % CI 0.64-0.92), reoperation (OR 0.69, 95 % CI 0.52-0.90), and readmission (OR 0.73, 95 % CI 0.61-0.88) compared to LV-SG surgeons. HV-RYGB surgeons had lower 30-day complication rates (OR 0.80, 95 % CI 0.69-0.92), but were without differences in reoperation (OR 0.82, 95 % CI 0.61-1.10) or readmission (OR 1.06, 95 % CI 0.88-1.27) compared to LV-RYGB surgeons.

CONCLUSIONS: High SG volume is associated with improved 30-day readmission, reoperation, and complication rates. Concurrent RYGB volume impacts the 30-day complication rate after SG, but does not affect the readmission or reoperation rate. Our findings suggest that SG-specific volume is important for optimal safety outcomes in SG patients.