In a recent article, Relationship between surgeon volume and adverse outcomes after RYGB in Longitudinal Assessment of Bariatric Surgery, by Mark Smith et al, in the March/April edition of Surgery for Obesity and related Diseases, the official journal of the American Society for Metabolic and Bariatric Surgeons showed that the frequency of serious complications decreases as the annual number of Roux en-Y Gastric Bypass operations performed by a bariatric surgeon increases.
In other words a bariatric surgeon that does a large number of gastric bypass operations, (100-150), each year is likely to have less adverse outcomes such as 1) blood clots formed in the legs. 2) blood clots that leave the legs and pelvis and go to the lungs, 3) need for reoperation, 4). delayed time in the hospital of 30 days and 5) death.
This was true for patients at high levels of risk, medium levels of risk and even patients at low levels of risk as determined before surgery.
Although this study was evaluating patients having a gastric bypass I suspect it is probably true regardless of which operation you chose.
How might this information be important to you? Patients considering bariatric surgery should investigate how often a surgeon performs a specific bariatric operation before deciding which surgeon to choose to do the operation. I also believe it is important to investigate what are the outcomes that patients have after being operated on at a particular program as well as by a particular surgeon.
Your questions should include:
How many of these operations did you perform last year?, (it is best if the number exceeds 100 for gastric bypass)
Where can I find the answers to the following questions if a form that is available to the public?
What is the average loss of excess weight at 1 year for patients you have performed this operation on? (the average is 62% at 1 year for gastric bypass and probably about the same for a gastric sleeve, the average is 48% at 3 years for gastric band patients. Some programs reach about 80% excess weight loss for each of these categories if they have a very robust program to help you get your best result like the Fresh Start Bariatrics program)
How frequently have your patients had the following problems after surgery:
Blood clots in the legs, (should be much less than 1 in 100)
Blood clots to the lungs, (should be much less than 1 in 100)
Leak from a staple line, (should be less than 2 in 100)
How often do you need to return someone to the operating room, (should be less than 2 in 100)
How many patients have died after a bariatric operation that you have performed? How many in the last 500 operations?, (should be 1 or less but remember the number may not be zero since some of the patients are high risk because of severe medical problems and may not survive much longer with out surgery)
These questions will help to guide you so you will make a wise choice for your surgeon.
I believe the quality of the overall program is also very important and I will discuss this in this blog tomorrow.
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