Bariatric peri-operative outcomes are affected by annual procedure-specific surgeon volume

Background: There is limited data examining specific annual surgeon procedural volumes associated with improvement of postoperative outcomes following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Objectives: Effect of surgeon volume on procedural outcomes. Methods: Using the SPARCS Administrative database, patients undergoing laparoscopic RYGB or SG between 2010–2014 were analyzed. Multivariable generalized linear mixed regression models were first used to analyze the influences of 3 yearly mean volumes (combined, RYGB and SG mean volumes) on each of three surgical outcomes: 30-day readmission, peri-operative complications, and extended length of stay (LOS), while accounting for patient specific variables. Results: A total of 46,511 laparoscopic bariatric procedures were included in the study. Risk for any complication and 30-day readmissions following RYGB decreased with increasing RYGB volume up to a specific volume and stayed similar afterward (OR 0.97, 95% CI 0.96–0.98 while volume < 247.9 cases/year and OR 0.99, 95% CI 0.98–0.99 while volume < 354.1 cases/year, respectively) while risk for extended LOS decreased with increasing combined bariatric mean volume up to a specific volume and stayed similar afterward (OR 0.9, 95% CI 0.85–0.95 while volume < 62.1 cases/year). Similar patterns were found for extended LOS and complications following SG (OR 0.82, 95% CI 0.72–0.93 while SG volume < 26.3 cases/year and OR 0.94, 95% CI 0.91–0.98 while combined volume < 62.1 cases/year, respectively), while 30-day readmission following SG significantly increased when combined bariatric volume being more than 138 cases/year (OR 1.10, 95% CI 1.00–1.21 while combined volume > 138 cases/year)). Conclusions: Bariatric procedure peri-operative outcomes are affected by procedure-specific annual surgeons’ volume.