Background

We aim to evaluate quality outcomes in the transition period from training to independent bariatric practice.

Methods

We utilized prospectively collected databases from two distinct healthcare systems. Cases between August 2021 and July 2022 were performed by a bariatric fellow who subsequently transitioned to independent practice in August 2022. Data obtained included patient demographics, post-operative complications, Emergency Department (ED) visitations, and readmissions.

Results

772 patients who underwent gastric bypass, sleeve gastrectomy and revisional procedures between August 2021 and September 2023 were included. The average starting pre-operative BMIs (43.9 vs 44.6, p=0.13)) and age (43 vs 44, p=0.20) of patients were not significantly different across the fellowship and independent practice cohorts. There was a higher proportion of technically difficult cases performed during fellowship than during transition to independent practice (sleeve versus gastric bypass or revisional procedures) (p <0.01). While there were more Clavien-Dindo Grade I complications in the transition to independent practice cohort, there was a lower rate of serious complications overall during the transition to independent practice year, with more Grade III+ complications seen during fellowship (p<0.01).

Conclusions

Fellowship involved significantly more exposure to technically challenging cases compared to transition to independent practice. While there was a higher rate of patient complications during fellowship year, this might be correlated to the higher proportion of complex cases as the majority of grade 3+ complications incurred during fellowship were associated with revisional or gastric bypass procedures.