Hospital variation in perioperative complications for laparoscopic sleeve gastrectomy in Michigan.
BACKGROUND
Laparoscopic sleeve gastrectomy has surpassed gastric bypass and laparoscopic adjustable gastric banding recently as the most common weight-loss procedure. Previously, substantial concerns existed regarding variation in perioperative safety with bariatric surgery. This study aimed to assess rates of perioperative complications for laparoscopic sleeve gastrectomy across hospitals and in relation to procedure volume within the Michigan Bariatric Surgery Collaborative.


METHODS
We analyzed 8,693 patients who underwent laparoscopic sleeve gastrectomy from 2013 through 2014 across 40 hospitals in the Michigan Bariatric Surgery Collaborative. Mixed-effects logistic regression was used to assess hospital variation in risk- and reliability-adjusted rates of overall and serious 30-day complications and their relationship with hospital annual volume of stapling procedures (gastric bypass and sleeve gastrectomy).


RESULTS
Overall, 5.4% of patients experienced perioperative complications. Adjusted rates of overall complications varied three-fold across hospitals, ranging from 3.6% (95% confidence interval 1.9-6.8%) to 11.0% (95% confidence interval 7.7-15.5%). Serious complications occurred in just 1.2% of patients and varied minimally. In this analysis, hospital volume was not associated with overall or serious complications. The 1 hospital with significantly less overall complication rates was high-volume (≥ 125 procedures/year); however, of the 4 hospitals with significantly greater complication rates, 3 were medium-volume (50-124 procedures/year), and 1 was high-volume. The remaining hospitals were not significantly different than the cohort mean.


CONCLUSIONS
Serious complications among patients undergoing laparoscopic sleeve gastrectomy were relatively infrequent in this cohort of patients in the Michigan Bariatric Surgery Collaborative. Rates of overall complications varied widely across the hospitals enrolled in this statewide quality collaborative, although this variation was unrelated to volume standards required for accreditation as a comprehensive bariatric surgery center.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; University of Michigan Medical School, University of Michigan, Ann Arbor, MI. Electronic address: jcprad@med.umich.edu.
Jason C
JC
Pradarelli
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI; Michigan Bariatric Surgery Collaborative.
Oliver A
OA
Varban
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI; Michigan Bariatric Surgery Collaborative.
Amir A
AA
Ghaferi
Michigan Bariatric Surgery Collaborative.
Matthew
M
Weiner
Wayne State University School of Medicine, Detroit, MI; Michigan Bariatric Surgery Collaborative.
Arthur M
AM
Carlin
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI; Michigan Bariatric Surgery Collaborative.
Justin B
JB
Dimick
D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*