Predictors of outcome after obesity surgery in New York state from 1991 to 2003.
BACKGROUND
This study aimed to examine hospital volume in New York state as a predictor of complications over 13 years.


METHODS
Data from the New York state Statewide Planning and Research Cooperative Systems database were analyzed by diagnosis-related group, patient demographics, and outcomes. The institution data were analyzed on the basis of volume and logistic regression using chi-square analysis for predicting morbidity and mortality.


RESULTS
From 1991 to 2003, 24,534 patients underwent bariatric surgery at 79 institutions. Case volume increased 36-fold in high-volume centers (HVCs), whereas the overall number of institutions doubled. The average mortality rate was 1.1% in low-volume centers (LVCs), 0.4% in medium-volume centers (MVCs), and 0.2% in HVCs. Whereas 12.4% of the LVC patients had postoperative anastomotic complications (PACs), only 9.7% had PACs in MVCs and only 7.3% had PACs in HVCs (p < 0.05). Furthermore, only 0.7% of the patients required postoperative reintubation (PRI) after surgery at HVCs, as compared with 1.5% at MVCs and 1.8% at LVCs (p < 0.05). Finally, 1.8% of the patients required blood transfusion of packed red blood cells at HVCs, whereas 2.4% required transfusion at MVCs and LVCs.


CONCLUSIONS
Experience correlates with fewer postoperative complications, including death, in bariatric centers in New York state.
Parker
M
M
Department of Surgery, New York Medical College, Grasslands Road, Munger Pavilion, Valhalla, NY 10595, USA.
Loewen
M
M
Sullivan
T
T
Yatco
E
E
Cerabona
T
T
Savino
J A
JA
Kaul
A
A
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications