title: Surgeon case volume and readmissions after laparoscopic Roux-en-Y gastric bypass: more is less.
abstract: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a commonly performed bariatric procedure. Readmissions are used as a quality indicator with a nationwide emphasis on reduction. In LRYGB surgery, surgeon volume studies have focused on correlation with technical outcomes, offering limited data on readmissions. Our aim was to evaluate nationwide data to explore the relationship between surgeon case volume and hospital readmissions following LRYGB.
  
  
  
  The Bariatric Outcomes Longitudinal Database from 2011 was used for this study. Analysis was restricted to patients who underwent non-revisional LRYGB. Surgeons performing more than 50 LRYGB during the study period were defined as high-volume surgeons (HVS). Multivariable logistic regression modeling was used to control for patient demographics and comorbidities.
  
  
  
  We identified 32,521 patients who underwent LRYGB with an overall 30-day readmission rate of 5.5 %, mean age 45.7 (12.0) years, and mean BMI 47.2 (8.0) kg/m2. There were no major differences in BMI (47.3 ± 8.1 vs 47.1 ± 7.9, p = 0.282) or age (45.5 ± 12.0 vs 45.8 ± 12.0, p = 0.030) between low-volume surgeon (LVS) and HVS patients. After controlling for baseline characteristics, HVS patients were less likely to be readmitted compared to those with a LVS (OR = 0.85, 95 % CI 0.77-0.94), with a readmission rate of 5.2 vs 6.1 % (p = 0.001). Additionally, HVS patients had lower rates of 30-day mortality (OR = 0.50, 95 % CI 0.27-0.91), complication (OR = 0.81, 95 % CI 0.75-0.87), reoperation (OR = 0.82, 95 % CI 0.72-0.93), and anastomotic leak (OR = 0.64, 95 % CI 0.46-0.87).
  
  
  
  Readmission following LRYGB is significantly associated with surgeon operative volume; surgeons that perform fewer than 50 LRYGB per year are more likely to have 30-day readmissions and complications. Our findings support other more generalized studies suggesting surgeon case volume is inversely associated with increased risk of adverse outcomes and complications. As such, performance of LRYGB by HVS may decrease patient morbidity, hospital readmission, and overall healthcare utilization.
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Celio
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Kasten
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Burruss
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA. spaniolask@ecu.edu.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spaniolas
mesh_terms: D057868:Anastomotic Leak / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D015390:Gastric Bypass / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D066231:Surgeons; D014481:United States / Q000453:epidemiology
keywords: BOLD; Bariatric surgery; Gastric bypass; Readmission; Surgeon volume