The effect of surrogate procedure volume on bariatric surgery outcomes: do common laparoscopic general surgery procedures matter?
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BACKGROUND: A growing body of evidence shows that experience and acquired skills from surrogate surgical procedures may be transferrable to a specific index operation. It is unclear whether this applies to bariatric surgery. This study aims to determine whether there is a surrogate volume effect of common laparoscopic general surgery procedures on all-cause bariatric surgical morbidity. METHODS: This was a population-based study of all patients aged ≥ 18 who received a bariatric procedure in Ontario from 2008 to 2015. The main outcome of interest was all-cause morbidity during the index admission. All-cause morbidity included any documented complication which extended length of stay by 24 h or required reoperation. Bariatric cases included laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. Non-bariatric cases included three common laparoscopic general surgery procedures. RESULTS: 13,836 bariatric procedures were performed by 29 surgeons at nine centers of excellence. A reduction in all-cause morbidity was seen when bariatric surgeons exceeded 75 cases annually (OR 0.82, 95% CI 0.69-0.98, P = 0.023), with further reduction in increasing bariatric volume. However, the volume of non-bariatric surgeries did not significantly affect bariatric all-cause morbidity rates amongst bariatric surgeons, even when exceeding 100 cases (OR 0.84, 95% CI 0.61-1.12, P = 0.222). CONCLUSIONS: The present study suggests that experience and skills acquired in performing non-bariatric laparoscopic general surgery does not appear to affect all-cause morbidity in bariatric surgery. Therefore, only a surgeon's bariatric procedure volume should considered be a quality marker for outcomes after bariatric surgery.
