48 - Preissitzung
Felix Largiadèr Preissitzung
16. Mai 2019, 10:15 - 11:45, Bellavista 3+4, 6. OG
Defining global benchmarks in bariatric surgery. A multicenter analysis of minimally invasive Roux-en-Y gastric bypass and sleeve gastrectomy
D. Gero1, D. A. Raptis2, W. Vleeschouwers3, S. L. van Veldhuisen4, A. San Martin5, Y. Xiao6, M. Galvao7, M. Giorgi8, M. Benois9, F. Espinoza5, M. Hollyman10, A. Lloyd11, H. Hosa1, H. Schmidt1, J. L. Garcia-Galocha12, S. Van de Vrande13, S. Chiappetta14, E. Lo Menzo15, C. Mamédio Aboud7, S. Gagliardo Lüthy16, P. Orchard17, S. Rothe18, G. Prager18, D. J. Pournaras17, R. Cohen7, R. Rosenthal15, R. Weiner14, J. Himpens13, A. Torres12, K. Higa11, R. Welbourn10, M. Berry5, C. Boza5, A. Iannelli9, S. Vithiananthan8, R. Almino7, T. Olbers6, M. Sepulveda5, E. J. Hazebroek4, B. Dillemans3, R. D. Staiger1, M. A. Puhan1, R. Peterli16, M. Bueter1, Presenter: D. Gero1 (1Zurich, 2London/UK, 3Brugge/BE, 4Arnhem/NL, 5Las Condes/CL, 6Gothenburg/SE, 7Sao Paulo/BR, 8Providence/USA, 9Nice/FR, 10Taunton/UK, 11Fresno/USA, 12Madrid/ES, 13Dendermonde/BE, 14Offenbach/DE, 15Weston/USA, 16Basel, 17Bristol/UK, 18Vienna/AT)
Benchmarking uses best performance in a given field as reference point for others to improve. Surgical benchmarks –best achievable results– were recently introduced in outcome research. Our aim was to identify the global benchmarks for bariatric surgery (BS) (Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]).
The establishment of BS benchmarks followed a standardized methodology, previously applied for liver surgery and esophagectomy. Out of 39424 elective bariatric procedures performed in 19 high volume academic centers on 3 continents between 06/2012–05/2017, we identified 4120 RYGB and 1457 SG benchmark cases based on preoperative risk-factors (Fig. 1). Benchmark patients had no: previous abdominal surgery, concomitant procedures, diabetes, sleep apnea, cardiopathy, renal insufficiency, IBD, immunosuppression, anti-coagulation, BMI>50kg/m2, age>65 years and were followed-up for minimum 90-days. We chose clinically relevant endpoints covering intra- and postoperative course, with a focus on complications graded by severity, using the Clavien-Dindo classification and the comprehensive complication index (CCI®). Benchmark cut-offs were set at the 75th percentile of the included centers’ median value for respective outcomes (R software).
BS patients were mainly females (78%), aged 38±11 years, with a baseline BMI of 40.8±5.8 kg/m2. Benchmark cutoffs for surgical quality indicators are presented in Table 1 for RYGB, and in Table 2 for SG. During the first 90-days, 7.2% of RYGB and 6.2% of SG patients presented at least 1 complication. For RYGB and SG alike, most readmissions occurred beyond 90-days (Fig. 2), and were most frequently due to symptomatic cholelithiasis or abdominal pain of unknown origin (Fig. 3).
Benchmark cutoffs targeting peri-operative outcomes in BS offer a new tool in surgical quality-metrics and may be implemented in the quality-improvement cycle. In high-volume centers, the 90-day postoperative morbidity of BS in low-risk patients is remarkably low and the mortality is zero. However, re-interventions increase with time after surgery and may not entirely depend on baseline patient factors or surgical performance (i.e.: abdominal pain of unknown origin or weight-loss induced cholelithiasis). This emphasizes the need for BS centers to show commitment to long-term follow-up of bariatric patients.