title: Hospital variation in rates of acid-reducing medication use after laparoscopic sleeve gastrectomy.
abstract: BACKGROUND
  Postoperative gastroesophageal reflux is one of the most important long-term complications of sleeve gastrectomy, the most common bariatric procedure.
  
  
  OBJECTIVE
  To assess variation in hospital performance with laparoscopic sleeve gastrectomy using rates of acid-reducing medication use at postoperative 1 year.
  
  
  METHODS
  Clinical registry of bariatric surgical patients at academic and community hospitals in Michigan.
  
  
  METHODS
  We studied 2923 patients who underwent laparoscopic sleeve gastrectomy across 39 hospitals in the Michigan Bariatric Surgery Collaborative, 2007 to 2014. We compared risk- and reliability-adjusted rates of new-onset reflux-defined by new use of acid-reducing medication-across hospitals and in relation to surgical quality indicators (hospital procedure volume and 30-day complications).
  
  
  RESULTS
  Overall, 20% of patients were newly taking acid-reducing medication at postoperative 1 year. Hospital rates of new medication use varied 3-fold, ranging from 10% (95% CI 7-15%) to 31% (95% CI 23-40%) of patients. Of the 2 hospitals with significantly lower rates of new medication use, 1 was high volume and 1 was medium volume. The 1 hospital with significantly higher rates was medium volume. Rates of acid-reducing medication use did not correlate with hospital volume or perioperative complications.
  
  
  CONCLUSIONS
  Across Michigan hospitals, rates of new acid-reducing medication use at 1 year after laparoscopic sleeve gastrectomy varied widely and did not correlate with traditional quality indicators. Future research could explore differences in surgical technique to better understand the factors underlying variation in long-term outcomes after sleeve gastrectomy.
authors.affiliation: Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan. Electronic address: jcprad@med.umich.edu.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Pradarelli
authors.affiliation: Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, University of Michigan, Ann Arbor, Michigan.
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Varban
authors.affiliation: Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, University of Michigan, Ann Arbor, Michigan.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
mesh_terms: D000863:Antacids / Q000627:therapeutic use*; D050110:Bariatric Surgery / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000209:etiology; D006276:Health Facility Size / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology
chemical_list: D000863:Antacids
keywords: Acid-reducing medication; Hospital variation; Postoperative reflux; Sleeve gastrectomy