Grapevine, Tex. — Even for experienced bariatric surgeons operating at recognized centers of excellence, the adverse event rate for Roux-en-Y gastric bypass declines by 10% for every additional 10 cases performed annually, Dr. Mark D. Smith said at the annual meeting of the American Society for Metabolic and Bariatric Surgery.
Dr. Smith, a bariatric surgeon in Portland, Ore., reported on 3,409 patients who underwent an initial Roux-en-Y gastric bypass with 31 surgeons at 10 centers of excellence. All of the centers were participating in the National Institute of Diabetes and Digestive and Kidney Diseases–sponsored, prospective Longitudinal Assessment of Bariatric Surgery-1 (LABS-1) study.
Fifteen of the 31 surgeons averaged fewer than 50 of the procedures per year, 9 performed 50-99 annually, and 7 did 100 or more. The primary, composite 30-day adverse event end point comprised death, venous thromboembolism, reintervention, or hospitalization for the full 30 days. It occurred in 4.0% of patients whose surgeons performed at least 50 Roux-en-Y gastric bypasses annually and 9.1% of patients of lesser-volume surgeons. After adjustment for patients' operative risk, the relative risk of adverse events was 2.2-fold greater with surgeons who averaged fewer than 50 cases per year than with those who did more.
Further analysis showed that the inverse relationship between surgeon volume and adverse outcomes was continuous, and that for every 10 cases performed annually, the risk of adverse events decreased by 10%, said Dr. Smith.
Surgeons with fewer than 50 cases per year conferred twice the adverse event risk as those who had more than 50.
Source DR. SMITH