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Bariatric Outcomes Are Significantly Improved in Hospitals With Fellowship Council Accredited Bariatric Fellowships
Pamela Kim*, Dana a. Telem, Mark a. Talamini, Maria Altieri, Aurora D. Pryor
Surgery, Stony Brook University Medical Center, Stony Brook, NY
Introduction: Identifying hospital factors associated with improved outcome following bariatric surgery is of high priority. Previous studies centered on characteristics such as operative volume and Center-of-Excellence (COE) designation. Little is known regarding the impact of a fellowship training program on institutional outcomes. This study examines the effect of bariatric fellowship training program status on perioperative outcomes.
Methods: Following IRB approval, New York Statewide Planning and Research Cooperative System (SPARCS) administrative data was used to identify 47,342 adult patients in 91 hospitals who underwent bariatric surgery from 2004-2010. SPARCS is a comprehensive longitudinal data reporting system, which collects patient-level risk characteristics, treatments, and outcomes for all New York State (NYS) hospital discharges. Bariatric surgery was identified by discharges with a primary diagnosis of overweight or obesity and a primary procedure code for laparoscopic gastric band (LGB), laparoscopic Roux-en-y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG). Hospitals with fellowships were identified from the Fellowship Council website (n=12). Statistical comparison between patient demographics, co-morbidities present at the time of operation, bariatric procedure performed and perioperative complication in hospitals with versus without fellowship was performed via univariate and multivariable regression analysis.
Results: Of 47,342 patients, 11,343 patients underwent surgery in fellowship accredited hospitals versus 35,999 in hospitals without fellowship. Significant differences were demonstrated in patient demographics, comorbidity profiles and operative procedures performed in fellowship versus nonfellowship hospitals (Table). Univariate analysis initially demonstrated fellowship programs to have increased rates of cardiac complications (1.1%vs.0.6%, p<0.001) and shock (2.1%vs.1.3%,p<0.001) and decreased rates of pneumonia (0.5% vs. 0.7%,p=0.008). Overall complication rate was not significantly different in fellowship versus nonfellowship accredited hospitals (4.3%vs. 4.0%, p=0.18), respectively. No other differences in individual complications were demonstrated. Multivariable regression analysis controlling for patient demographic, co-morbidity, operative procedure and insurance payer demonstrated fellowship status significantly and independently correlated with improved perioperative outcome OR 0.88 (95%CI[0.78-0.98],p=0.02)
Conclusion: Fellowship accreditation status is associated with significantly improved bariatric outcomes in New York State. Differences in complications noted on univariate analysis likely reflect that fellowship accredited hospitals operate on higher risk patient populations and perform increased RYGB versus LGB.
Significant differences in patient demographics, co-morbidity profile and operative procedure in hospitals with versus without a Fellowship Council accredited bariatric fellowship program
| Patient Demographics | Fellowship Accredited Hospital (n=11,343) | Nonfellowship Accredited Hospital (n=35,999) | P-value | | Black | 13.7% | 12.8 % | <0.001 | | Hispanic | 19.2% | 9.4% | <0.001 | | White | 54.5% | 66.6 | <0.001 | | Medicaid | 7.8% | 3.2% | <0.001 | | Non CMS insured | 85.3% | 90.1% | <0.001 | | Patient Comorbidity | | | <0.001 | | Congestive heart failure | 3.7% | 3.0% | <0.001 | | Liver disease | 14.8% | 5.1% | <0.001 | | Pulmonary disease | 29.5% | 23.2% | <0.001 | | Operative Procedure | | | <0.001 | | Laparoscopic RYGB | 67.0% | 53.7% | <0.001 | | Laparoscopic AGB | 21.9% | 37.0% | <0.001 | | | | | | | | |
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