Background

Bariatric surgery volume requirements from historic data are a condition for accreditation. The aim of this study is to determine the volume outcome relationship for contemporary bariatric surgery.

Methods

The Nationwide Readmissions Database from 2018-2020 was utilized to capture laparoscopic sleeve gastrectomy (SG), gastric bypass (GB), and duodenal switch (DS) procedures via ICD-10/DRG codes for 266,743 procedures from 1947 hospitals. The hospital volume by procedure was divided into low, medium and high volume. Hospital volume was risk-adjusted by age, gender, and Elixhauser Index and correlated to the outcomes of Patient Safety Indicator (PSI) 90 (post-operative complications) and mortality.

Results

The algorithm yielded results for SG: n=184,863 procedures, range (1-876) with median values for low (13), medium (64) and high volume (174). For GB, n=77,269 procedures, range (1-443) with median values for low (6), medium (24) and high volume (68). For DS, n=4,611 procedures, range (1-194) with median values for low (2), medium (3) and high volume (9). In correlating hospital volume to PSI 90/mortality after risk adjustment, the following results are noted with high volume as reference value (OR=1). Sleeve Gastrectomy: low volume (OR 1.17, p=0.433) medium volume (OR 1.56, p<0.001) Gastric Bypass: low volume (OR 1.30, p=0.228) medium volume (OR 1.06, p=0.583) Duodenal Switch low volume (OR 2.6, p=0.2) medium volume (OR 2.16, p=0.035)

Conclusions

In this nationally representative database which allows for hospital volume identification, there was a significant reduction in adverse effects for high volume hospitals performing both sleeve gastrectomy and duodenal switch.