title: A state-wide review of contemporary outcomes of gastric bypass in Florida: does provider volume impact outcomes?
abstract: OBJECTIVE
  To report contemporary outcomes of gastric bypass for obesity and to assess the relationship between provider volume and outcomes.
  
  
  BACKGROUND
  Certain Florida-based insurers are denying patients access to bariatric surgery because of alleged high morbidity and mortality.
  
  
  METHODS
  The prospectively collected and mandatory-reported Florida-wide hospital discharge database was analyzed. Restrictive procedures such as adjustable gastric banding and gastroplasty were excluded.
  
  
  RESULTS
  The overall complication and in-hospital mortality rates in 19,174 patients who underwent gastric bypass from 1999 to 2003 were 9.3% (8.9-9.7) and 0.28% (0.21-0.36), respectively. Age and male gender were associated with increased duration of hospital stay (P < 0.001), increased in-hospital complications [age: odds ratio (OR) = 1.11, CI: 1.08-1.13; male: OR = 1.53, CI: 0.36-1.72] and increased in-hospital mortality (age: OR = 1.51, CI: 1.32-1.73; male: CI = 2.66, CI: 1.53-4.63), all P < 0.001. The odds of in-hospital complications significantly increased with diminishing surgeon or hospital procedure volume (surgeon: OR = 2.0, CI: 1.3-3.1; P < 0.001, 1-5 procedures relative to >500 procedures; hospital volume: OR = 2.1, CI: 1.2-3.5; P < 0.001, 1-9 procedures relative to >500 procedures). The percent change of in-hospital mortality in later years of the study was lowest, indicating higher mortality rates, for surgeons or hospitals with fewer (< or =100) compared with higher (> or =500) procedures.
  
  
  CONCLUSIONS
  Increased utilization of bariatric surgery in Florida is associated with overall favorable short-term outcomes. Older age and male gender were associated with increased morbidity and mortality. Surgeon and hospital procedure volume have an inverse relationship with in-hospital complications and mortality.
authors: Department of Surgery, University of South Florida Health Sciences Center, c/o Tampa General Hospital, Tampa, FL 33601, USA. mmurr@health.usf.edu
authors: Michel M
authors: MM
authors: Murr
authors: Taylor
authors: T
authors: Martin
authors: Krista
authors: K
authors: Haines
authors: Tracy
authors: T
authors: Torrella
authors: Robert
authors: R
authors: Dragotti
authors: Ali
authors: A
authors: Kandil
authors: Scott F
authors: SF
authors: Gallagher
authors: Scott
authors: S
authors: Harmsen
mesh_terms: D000328:Adult; D000367:Age Factors; D002983:Clinical Competence; D005260:Female; D005431:Florida / Q000453:epidemiology; D015390:Gastric Bypass / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D012737:Sex Factors; D016526:Workload