The effect of hospital teaching status on outcomes in bariatric surgery

Abstract

Background: Studies have shown conflicting effects of resident involvement on outcomes after laparoscopic bariatric surgery. Resident involvement may be a proxy for a teaching environment in which multiple factors affect patient outcomes. However, no study has examined outcomes of laparoscopic bariatric surgery based on hospital teaching status. Objective: To compare outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) between teaching hospitals (THs) and nonteaching hospitals (NTHs). Setting: Retrospective review of a national database in the United States. Methods: The Nationwide Inpatient Sample database (2011–2013) was reviewed for obese patients who underwent LRYGB or LSG. Patient demographic characteristics and outcomes were analyzed according to hospital teaching status. Primary outcome measures included risk-adjusted inpatient mortality and serious morbidity. Results: We analyzed 32,449 LRYGBs and 26,075 LSGs. There were 35,160 (60.1%) cases performed at THs and 23,364 (39.9%) cases performed at NTHs. At THs, the distribution of LRYGB versus LSG cases was 20,461 (58.2%) versus 14,699 (41.8%), respectively; at NTHs, the distribution was 11,988 (51.3%) versus 11,376 (48.7%), respectively. For LRYGB, there were no significant differences between THs versus NTHs in mortality (AOR 1.14; P = 0.99), but there was an increase in odds of serious morbidity at THs (AOR 1.36; P < 0.001). For LSG, there were no significant differences between THs versus NTHs for mortality (AOR 1.15; P = 0.99) or serious morbidity (AOR 1.03; P = 0.99). Conclusions: There is an association between THs and increased serious morbidity for LRYGB, but hospital teaching status has no effect on morbidity or mortality after LSG. Further research is warranted to elucidate the reasons for these associations.

Patterns of Bariatric Surgeries Among U.S. Women Diagnosed with Polycystic Ovarian Syndrome

“…Disparities in the utilization of bariatric surgeries according to patient level (sex, age, race, income, health insurance, and comorbidities) and hospital level (region, urban-rural status, teaching status, and volume) were similarly reported by previously published studies that performed secondary analyses of the NIS data. 24,26,29 To our knowledge, this study is the first to examine bariatric surgeries among obese/overweight PCOS women using a nationally representative sample of hospitalized patients. Recently published studies have also used NIS data to examine utilization and outcomes of bariatric surgeries among special populations, including uncomplicated diabetes, 17 celiac disease, 18 HIV infection, 30 inflammatory bowel disease, 20,31 hepatocellular carcinoma, 32 non-alcoholic fatty liver disease, 19 and acute pancreatitis.…”

“…Previously conducted NIS-based studies that compared at least two of these techniques also found variability in terms of in-hospital outcomes. 17,24,25 For instance, a recent study of uncomplicated diabetic patients by Baffoe et al used the 2009-2014 NIS data and found that the chance of extended length of stay (>2 days) was less among patients who underwent LSG than those who underwent LAGB, control-ling for confounders. 17 Similarly, a study by Khan et al using the 2008-2012 NIS data found that LAGB and LSG had the lowest rates of complications, in-hospital morbidity and mortality, and the shortest length of stay, whereas open bypass and duodenal switch had the highest rates of complications, in-hospital morbidity and mortality, and the longest hospitalizations.…”

“…These eligibility criteria were selected based on recently published reports that analyzed data from the NIS with an emphasis on bariatric surgery. [18][19][20][22][23][24][25][26] Measures Obesity/overweight diagnosis was defined based on ICD-9-CM diagnostic codes as a dichotomous (yes or no) variable. Among obese/overweight PCOS women, bariatric surgery utilization was defined as a dichotomous (yes or no) variable and type of bariatric surgery was categorized as follows: (1) RYGB, (2) LSG, (3) LAGP, (4) Other, and (5) Unspecified.…”