title: Laparoscopic Roux-en-Y gastric bypass at a Veterans Affairs and high-volume academic facilities: a comparison of institutional outcomes.
abstract: BACKGROUND
  Outcomes of bariatric surgery have been linked to institutional case volume. The objective of our study was to compare outcome of laparoscopic Roux-en-y gastric bypass (RYGB) in 2 settings: a low-volume Veterans Affairs (VA) and a high-volume university hospital (UH).
  
  
  METHODS
  Over a period of 27 months, 140 patients underwent RYGB (137 laparoscopic, 3 open) performed by 1 surgeon. Fifty-five were performed at a VA and 85 at a UH with an annual caseload close to 300.
  
  
  RESULTS
  The body mass index in both groups was similar, but patients at the VA were older, mostly men, and more likely to have hypertension (HTN), obstructive sleep apnea, and diabetes mellitus (DM). Operative and anesthesia times were significantly longer at the VA. There were no differences in 30-day mortality (none), major morbidity, conversion rates, or reoperation rates.
  
  
  CONCLUSIONS
  Laparoscopic RYGB can be performed safely at a VA facility despite a higher risk population and low annual volume.
authors.affiliation: Department of Surgery, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave., 112G, Palo Alto, CA 94303, USA.
authors.forename: Ramzi S
authors.initials: RS
authors.lastname: Alami
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
authors.forename: Barry R
authors.initials: BR
authors.lastname: Sanchez
authors.forename: Myriam J
authors.initials: MJ
authors.lastname: Curet
authors.forename: Sherry M
authors.initials: SM
authors.lastname: Wren
authors.forename: Bassem Y
authors.initials: BY
authors.lastname: Safadi
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D015390:Gastric Bypass; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs