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Weight Loss Surgery: Experience Matters

Surgeon Experience and Hospital Volume Most Important Criteria, Study Finds

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July 27, 2010 -- People considering weight loss surgery can reduce their risk of complications by choosing a surgeon and hospital with a lot of experience performing the procedures, according to new research published in this week’s Journal of the American Medical Association.

The study of outcomes among more than 15,000 bariatric surgery patients in Michigan showed a very low rate of serious complications and death.

Avoiding Complications

But potentially life-threatening complications occurred at twice the rate in patients whose surgeries were performed by the least experienced surgeons compared to the most experienced.

Likewise, the serious complication rate was almost twice as high for patients whose surgeries were performed at the lowest-volume hospitals compared to facilities where bariatric surgery was performed most often.

For low-volume surgeons working at low-volume hospitals, the serious complication rate was 4%, compared to 1.9% for high-volume surgeons working at high-volume hospitals, says lead researcher Nancy J.O. Birkmeyer, PhD, of the University of Michigan, Ann Arbor.

Surprisingly, hospitals accredited as centers of excellence (COE) in bariatric surgery had similar rates of serious complications and slightly worse surgical outcomes than centers without the designation, she says.

“In the absence of reliable data on outcomes, patients should seek out high-volume hospitals and surgeons when considering bariatric surgery,” Birkmeyer tells WebMD. “Whether or not the hospital has a COE certification doesn’t seem to matter all that much.”

More Than 200,000 Surgeries a Year

About 220,000 people in the United States had weight loss surgery in 2009, according to the American Society for Metabolic and Bariatric Surgery (ASMBS). That is a more than tenfold annual increase in the surgeries in less than a decade.

In the newly published study, Birkmeyer and colleagues compared complication rates at 25 Michigan hospitals for three weight loss procedures: gastric bypass surgery, lap banding, and a relatively new procedure known as sleeve gastrectomy. All the procedures were performed between 2006 and 2009.

The study found that:

  • The overall complication rate for the three procedures was about 7%, with wound complications reported most often.
  • Serious complications were most common following gastric bypass (3.6%), followed by sleeve gastrectomy (2.2%) and adjustable gastric lap banding (0.9%).
  • The rate of serious complications at hospitals with COE accreditation was 2.7%, compared to 2% at hospitals without the accreditation. The rates were not found to be significantly different.
  • The overall death rate was 0.12%, and just two deaths related to surgery were reported in Michigan in 2009, Birkmeyer says.


Message to Patients: ‘Do Your Homework’

Birkmeyer credits the low complication rate to an aggressive statewide quality improvement initiative run by Blue Cross-Blue Shield Michigan, which also funded the study.

About 95% of the hospitals and surgeons performing bariatric surgeries in the state belong to the initiative, which includes a registry of patient complications.

“Surgeons meet three times a year and they are really committed to improving quality,” she says.

Surgeon Rick May, MD, who is a vice president with the health care performance ratings group HealthGrades, says patients considering weight loss surgery today have many resources to educate themselves about the procedures and the facilities in which they are performed.

A recent HealthGrade study that May co-authored found a big difference in complication rates and outcomes among the nation’s hospitals, with the highest-volume facilities reporting the fewest complications.

“There has been an explosion of information to help patients chose the right hospital and surgeon,” he tells WebMD. “With bariatric surgery, people have time to check out different options. They should talk to several surgeons and ask for references from patients.”

Mitchell Roslin, MD, who is chief of obesity surgery at New York City’s Lenox Hill Hospital, says patients are using the resources.

“Patients are doing their homework and asking questions,” he says. “There is probably no group of patients who use the Internet to get information more than mine do.”

He tells WebMD that he is not surprised hospitals with “center of excellence” accreditations fared no better than other hospitals in the study.

“These procedures have become safer as surgeons have become more accustomed to doing them,” he says. “These regulatory groups have taken credit for this improvement, but that credit is not deserved.”

WebMD Health News Reviewed by Louise Chang, MD on 7/, 010



Birkmeyer, N.J.O. Journal of the American Medical Association, July 28, 2010; vol 304: pp 435-442.

Nancy J. O. Birkmeyer, PhD, assistant professor and senior scientist, Center for Health Outcomes and Policy, University of Michigan at Ann Arbor.

Mitchell Roslin, MD, chief of obesity surgery, Lenox Hill Hospital, New York.

New release, Journal of the American Medical Association.

American Society for Metabolic and Bariatric Surgery: "Bariatric Surgery Fact Sheet."

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