Oregon Weight Loss Surgery, Portland, OR 97210, USA.
Surg Obes Relat Dis. 2010 Mar 4;6(2):118-25. doi: 10.1016/j.soard.2009.09.009. Epub 2009 Sep 26.
Bariatric surgery is technically demanding surgery performed on high-risk patients. Previous studies using administrative databases have shown a relationship between surgeon volume and patient outcome after Roux-en-Y gastric bypass (RYGB). We examined the relationship between surgeons' annual RYGB volumes and 30-day patient outcomes at 10 centers within the United States.
The Longitudinal Assessment of Bariatric Surgery (LABS)-1 is a prospective study examining the 30-day adverse outcomes after bariatric surgery. The outcomes after RYGB were adjusted by procedure type (open versus laparoscopic), functional status, body mass index, history of deep vein thrombosis, pulmonary embolism, and obstructive sleep apnea. The data were examined to determine the nature and strength of the association between surgeon volume and patients' short-term (30-day) adverse outcomes after RYGB.
The analysis included 3410 initial RYGB operations performed by 31 surgeons, 15 of whom averaged <50 cases annually. The crude composite adverse outcome (i.e., death, deep vein thrombosis, pulmonary embolism, reintervention or nondischarge at day 30) incidence was 5.2%. After risk adjustment, a greater surgeon RYGB volume was associated with lower composite event rates, with a continuous relationship (i.e., varying cutpoints differentiated the composite event rates), such that for each 10-case/yr increase in volume, the risk of a composite event decreased by 10%.
In the LABS, the patient's risk of an adverse outcome after RYGB decreased significantly with the increase in surgeon RYGB volume (cases performed annually).
减重手术是一项对高危患者实施的技术要求很高的手术。先前使用行政数据库的研究表明，胃旁路手术（RYGB）后外科医生的手术量与患者的结果之间存在关系。我们在美国的 10 个中心检查了外科医生每年 RYGB 量与 30 天患者结果之间的关系。
纵向评估减重手术（LABS）-1 是一项前瞻性研究，检查减重手术后 30 天的不良结果。RYGB 后的结果通过手术类型（开放与腹腔镜）、功能状态、体重指数、深静脉血栓形成史、肺栓塞和阻塞性睡眠呼吸暂停进行调整。检查数据以确定外科医生手术量与患者 RYGB 后短期（30 天）不良结果之间的性质和强度的关联。
该分析包括 31 名外科医生进行的 3410 例初始 RYGB 手术，其中 15 名外科医生每年平均进行<50 例手术。复合不良结局（即死亡、深静脉血栓形成、肺栓塞、再干预或第 30 天未出院）的发生率为 5.2%。在风险调整后，外科医生 RYGB 量越大，复合事件发生率越低，且呈连续关系（即不同的切点区分了复合事件的发生率），即每年手术量增加 10 例，复合事件的风险降低 10%。
在 LABS 中，患者 RYGB 后不良结局的风险随着外科医生 RYGB 量（每年进行的手术量）的增加而显著降低。
