The Effect of Bariatric Surgery Volume on General Surgery Outcomes for Morbidly Obese Patients
Table 1
Preoperative comorbidities and postoperative complications of patients with morbid obesity undergoing cholecystectomy, appendectomy, or ventral hernia repair.
Preoperative variables
HVBH n = 3,867 Weighted n = 19,335
LVBH n = 10,161 Weighted n = 50,805
value unadjusted
Age (years, mean±SE)
50.5 ± 0.3
51.2 ± 0.2
0.03
Length of stay (days, mean±SE)
4.9 ± 0.1
5.4 ± 0.1
<0.0001
Median household income quartile for zip code
2.32 ± 0.04
2.25 ± 0.02
0.0005
Gender, female (% ± SE)
72.7 ± 0.8
69.4 ± 0.5
0.0003
Renal failure (% ± SE)
1.1 ± 0.2
1.5 ± 0.1
0.08
Hypertension (% ± SE)
52.4 ± 0.9
49.3 ± 0.5
0.002
Chronic obstructive pulmonary sis. (% ± SE)
8.9 ± 0.5
10.3 ± 0.3
0.03
Diabetes mellitus type 2 (% ± SE)
10.2 ± 0.6
9.8 ± 0.3
0.51
Anemia (% ± SE)
0.78 ± 0.18
0.53 ± 0.07
0.15
Gastroesophageal reflux disease (% ± SE)
33.2 ± 1.0
24.9 ± 0.5
<0.0001
Chronic peptic ulcer disease (% ± SE)
0.72 ± 0.15
0.82 ± 0.09
0.61
Heart failure (% ± SE)
7.5 ± 0.5
8.4 ± 0.3
0.10
Hypothyroidism (% ± SE)
12.7 ± 0.5
12.7 ± 0.3
0.97
History of venous thromboembolism (% ± SE)
4.1 ± 0.4
3.1 ± 0.2
0.005
History of pulmonary embolism (% ± SE)
3.4 ± 0.3
2.1 ± 0.1
<0.0001
Nicotine dependence (% ± SE)
20.1 ± 0.9
16.6 ± 0.4
0.0001
Obstructive sleep apnea (% ± SE)
35.2 ± 1.3
24.8 ± 0.5
<0.0001
Postprocedure complications
HVBH
LVBH
value unadjusted
ATE (95% CI)
value adjusted
Cerebrovascular infarct (% ± SE)
0.03 ± 0.03
0.03 ± 0.02
0.91
—
—
Shock (% ± SE)
0.39 ± 0.12
0.29 ± 0.05
0.39
—
—
Hemorrhage or hematoma (% ± SE)
0.18 ± 0.07
0.18 ± 0.04
0.96
—
—
Bowel obstruction (% ± SE)
1.99 ± 0.26
2.82 ± 0.18
0.01
−0.76 (−1.36/0.16)
0.01
Enterotomy (% ± SE)
0.57 ± 0.13
0.67 ± 0.08
0.53
—
—
GI bleed (% ± SE)
0.41 ± 0.10
0.53 ± 0.07
0.36
−0.19 (−0.44/0.06)
0.13
Pulmonary insufficiency (% ± SE)
0.31 ± 0.10
0.2 ± 0.05
0.25
—
—
Pulmonary failure (% ± SE)
1.55 ± 0.21
2.9 ± 0.18
<0.0001
−1.31 (−1.93/−0.69)
<0.0001
Pneumonia (% ± SE)
0.41 ± 0.11
0.5 ± 0.07
0.51
—
—
Genitourinary complication (% ± SE)
0.16 ± 0.06
0.14 ± 0.04
0.81
—
—
Postoperative infection (% ± SE)
1.14 ± 0.19
1.46 ± 0.11
0.18
−0.59 (−1.01/−0.18)
0.005
Wound complication (% ± SE)
0.16 ± 0.06
0.12 ± 0.03
0.58
−0.42 (−0.80/−0.03)
0.03
Venous thromboembolism (% ± SE)
0.31 ± 0.09
0.45 ± 0.07
0.24
—
—
Pulmonary embolism (% ± SE)
0.65 ± 0.14
0.54 ± 0.07
0.49
—
—
“Other” complications (% ± SE)
0.18 ± 0.07
0.27 ± 0.05
0.36
—
—
Death (% ± SE)
0.59 ± 0.12
0.8 ± 0.09
0.19
−0.10 (−0.47/0.27)
0.60
Patient had any complication (% ± SE)
7.8 ± 0.5
10.3 ± 0.3
<0.0001
−3.32 (−4.43/−2.21)
<0.0001
HVBH: high volume bariatric hospital; LVBH: low volume bariatric hospital; ATE: average treatment effect.
