Mortality and hospital stay after bariatric surgery in 2,167 patients: influence of the surgeon expertise.
BACKGROUND
Postoperative mortality is a rare event after bariatric surgery. The main goal of this study was to calculate the 30-day mortality rate postbariatric "open" surgery and the length of hospital stay of patients assisted by a health maintenance organization in Brazil. We also investigate their association with sex, age, BMI, preexisting comorbidities, and volume of procedures performed by surgeons.


METHODS
A total of 2,167 patients who underwent RYGB between 01/2004 and 12/2007 were analyzed. The deaths and hospital stay were identified in the healthcare transactional database and the morbidity data in the preoperative medical audit records. Factors contributing to adverse outcomes were determined by multiple logistic regression analysis.


RESULTS
The overall mortality rate was 0.64%, with a decreasing trend over the years. The median hospital stay was 3.1 days. In the multivariate analysis, both mortality and longer hospital stay were positively and significantly associated with age > 50 years, BMI > 50 kg/m(2), and surgeon volume of less than 20 bariatric surgeries/year. Presence of hypertension also increased the risk of longer hospital stay. Multivariate analysis showed that the 30-day mortality was six times higher in patients operated by professionals who performed less surgeries/year and longer hospital stay, four times more frequent.


CONCLUSIONS
The 30-day mortality post-RYGB is similar to the rates found in developed countries and much lower than the rates found for patients assisted by the public health system in Brazil. In addition to age and clinical factors, the results suggest that mortality and longer hospital stay are strong and inversely related to surgeon's experience.
Kelles
Silvana Márcia Bruschi
SM
Program of Post-graduation on Adults Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. silvanakelles@terra.com.br
Barreto
Sandhi Maria
SM
Guerra
Henrique Leonardo
HL
D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D002983:Clinical Competence; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000401:mortality*; D006279:Health Maintenance Organizations; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult