• Surgery · Nov 2008

    Multicenter Study

    Surgical volume impacts bariatric surgery mortality: a case for centers of excellence.

    • Christopher S Hollenbeak, Ann M Rogers, Bryan Barrus, Irfan Wadiwala, and Robert N Cooney.
    • Department of Surgery, The Penn State Milton S Hershey Medical Center, Hershey, PA 17033, USA.
    • Surgery. 2008 Nov 1; 144 (5): 736-43.

    BackgroundConcerns regarding care quality prompted credentialing processes for bariatric "Centers of Excellence" (COE). It is hypothesized that high-volume surgeons and hospitals have better outcomes.ObjectiveThis population-based study examines the effect of bariatric surgery volume on mortality in Pennsylvania.MethodsBetween 1999 and 2003, 14,716 patients having gastric bypass surgery in Pennsylvania hospitals were identified from the Pennsylvania Health Care Cost Containment Council database. Individual surgeons and hospitals were stratified as high (> 100 cases/yr), medium (50-100 cases/yr), or low volume (< 50 cases/yr). The relationship between surgeon and hospital volume on length of stay (LOS), in-hospital, and 30-day mortality were examined, adjusting for age, gender, ethnicity, payor, and MedisGroups Admission Severity Group (ASG) score.ResultsThere were 26-50 low (n = 2,158), 35-54 medium (n = 1,835), and 43-64 high (n = 10,723) volume hospitals in Pennsylvania. The mean volume/hospital increased between 1999 and 2003 (30-120 cases/yr) and in-hospital mortality decreased (0.8-0.2%). Thirty-day mortality (1.15%) was approximately 2 times the in-hospital mortality (0.37%). Male gender (odds ratio [OR] 3.6, P < .001), ASG (OR 2.5, P < .001), hospital and surgeon volume were associated with increased in-hospital and 30-day mortality. Controlling for other factors, patients treated by low- and medium-volume surgeons (OR 3.7, P = .002; OR 2.8, P = .015) and hospitals (OR 2.3, P = .01; OR 2.44, P = .017) had increased odds of 30-day mortality versus high-volume surgeons and hospitals. LOS was significantly shorter at high-volume hospitals as well.ConclusionsIn Pennsylvania, high volume is associated with decreased mortality and LOS. The results support the use of surgical volume in the COE credentialing process.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…