J Gastrointest Surg (2015) 19:594–597 DOI 10.1007/s11605-015-2758-7
2014 SSAT PLENARY PRESENTATION
Bariatric Outcomes are Significantly Improved in Hospitals with Fellowship Council-Accredited Bariatric Fellowships Pamela S. Kim & Dana A. Telem & Maria S. Altieri & Mark Talamini & Jie Yang & Qiao Zhang & Aurora D. Pryor
Received: 5 May 2014 / Accepted: 21 January 2015 / Published online: 10 February 2015 # 2015 The Society for Surgery of the Alimentary Tract
Abstract Background With the increasing demand of bariatric surgery, there is a need to train more surgeons, while identifying institutional factors associated with improved outcomes. Little is known regarding the impact of a fellowship training program on institutional outcomes. This study examines the effect of bariatric fellowship program status on perioperative outcomes within New York state. Methods Using the New York statewide planning and research cooperative system, 47,342 adult patients in 91 hospitals were identified who underwent a laparoscopic bariatric surgery over a 6-year period. Hospitals with fellowships were identified from the Fellowship Council. Statistical comparison between patient demographics, payer source, comorbidities, bariatric procedure performed, and perioperative outcomes in hospitals with and without fellowship were performed. Results On univariate analysis, fellowship accreditation status was found to be associated with increased rates of cardiac complications and shock and decreased rates of pneumonia. Overall complication rate was not significantly different in fellowship versus non-fellowship institutions. However, when controlled for patient demographic, payer source, comorbidity, and operative procedure, there were significantly improved bariatric outcomes among institutions with fellowship programs. Conclusions The presence of a fellowship program correlates with improved hospital outcomes, mitigating potential concerns about possible negative effects of trainees on hospitals and patients. Keywords Bariatric surgery . Fellowship . Outcomes
Presented at Plenary Session VIII at the 55th Annual Meeting of the SSAT at DDW, Chicago, Illinois, May 2014 P. S. Kim : D. A. Telem : M. S. Altieri : M. Talamini : A. D. Pryor (*) Department of Surgery, Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Stony Brook Medicine, 101 Nicolls Road, HSC 18-040, Stony Brook, NY 11794, USA e-mail: [email protected] J. Yang Department of Preventative Medicine, Stony Brook University, Stony Brook, NY, USA Q. Zhang Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
Introduction The prevalence of obesity is rapidly increasing in the USA today, with over ten million individuals considered to be morbidly obese. Obesity poses serious public health concerns and is now projected to overtake smoking as the leading cause of death – in the USA.1 3 As a result, the need for and demand of bariatric surgeries have grown exponentially over the past several years. As such, there is a need to train more surgeons in the skills necessary to practice bariatric surgery. Bariatric surgery as a field is technically challenging and requires complex treatment algorithms both preoperatively and postoperatively. It has been recognized that acquiring these complex operative , – skills requires a learning curve of 100 cases,2 4 8 which poses a significant potential risk of morbidity and mortality. With fellowship training however, the learning curve can be attenuated under the guidance of experienced surgeons. This way, complications can be minimized when they begin their own – practices.4 6 As a result, fellowship training in bariatric surgery is now almost a requirement to pursue this field.
J Gastrointest Surg (2015) 19:594–597
There is also the need to identify institutional factors associated with improved outcomes. It has been recognized that highvolume centers and physicians have improved outcomes, and this fact has been utilized to develop the Center of Excellence , , (COE) accreditation criteria.3 9 10 The American College of Surgeons and American Society for Metabolic and Bariatric Surgery have developed and implemented criteria which sets minimum standards for hospitals and surgeons wishing to obtain the , COE accreditation.3 11 Subsequently, COE status was, for a time, thought to be associated with improved outcomes. However, recent studies have shown that these institutions have no better , , – outcomes than other hospitals with equivalent volumes,2 3 9 11 and volume status is still the main driving force for improved outcomes. As we now see more high-volume institutions pursue fellowship training programs in an effort to keep up with the need for more surgeons, the impact of the presence of these trainees on outcomes is yet unclear but needs to be considered. Although the benefit of a bariatric fellowship training program to the trainee is apparent, the impact of such a program on the hospital and the patients it serve remains undefined. As such, the purpose of this study is to examine the effect of bariatric fellowship training program status on perioperative outcomes.
Methods Following Institutional Review Board and Department of Health approval, the New York statewide planning and research cooperative system (SPARCS) administrative data was used to identify 47,342 adult patients (≥18 years of age) in 91 hospitals who underwent bariatric surgery from 2004 to 2010. SPARCS is a comprehensive longitudinal data reporting system, which collects patient-level risk characteristics, treatments, and outcomes for all New York state hospital discharges. Bariatric surgery was identified by discharges with a primary diagnosis of overweight or obesity, and a primary procedure code for laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic gastric band (LGB), and laparoscopic sleeve gastrectomy (LSG). All non-primary procedures and revisional operations were excluded, as well as those patients with incomplete records or age
2014 SSAT PLENARY PRESENTATION
Bariatric Outcomes are Significantly Improved in Hospitals with Fellowship Council-Accredited Bariatric Fellowships Pamela S. Kim & Dana A. Telem & Maria S. Altieri & Mark Talamini & Jie Yang & Qiao Zhang & Aurora D. Pryor
Received: 5 May 2014 / Accepted: 21 January 2015 / Published online: 10 February 2015 # 2015 The Society for Surgery of the Alimentary Tract
Abstract Background With the increasing demand of bariatric surgery, there is a need to train more surgeons, while identifying institutional factors associated with improved outcomes. Little is known regarding the impact of a fellowship training program on institutional outcomes. This study examines the effect of bariatric fellowship program status on perioperative outcomes within New York state. Methods Using the New York statewide planning and research cooperative system, 47,342 adult patients in 91 hospitals were identified who underwent a laparoscopic bariatric surgery over a 6-year period. Hospitals with fellowships were identified from the Fellowship Council. Statistical comparison between patient demographics, payer source, comorbidities, bariatric procedure performed, and perioperative outcomes in hospitals with and without fellowship were performed. Results On univariate analysis, fellowship accreditation status was found to be associated with increased rates of cardiac complications and shock and decreased rates of pneumonia. Overall complication rate was not significantly different in fellowship versus non-fellowship institutions. However, when controlled for patient demographic, payer source, comorbidity, and operative procedure, there were significantly improved bariatric outcomes among institutions with fellowship programs. Conclusions The presence of a fellowship program correlates with improved hospital outcomes, mitigating potential concerns about possible negative effects of trainees on hospitals and patients. Keywords Bariatric surgery . Fellowship . Outcomes
Presented at Plenary Session VIII at the 55th Annual Meeting of the SSAT at DDW, Chicago, Illinois, May 2014 P. S. Kim : D. A. Telem : M. S. Altieri : M. Talamini : A. D. Pryor (*) Department of Surgery, Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Stony Brook Medicine, 101 Nicolls Road, HSC 18-040, Stony Brook, NY 11794, USA e-mail: [email protected] J. Yang Department of Preventative Medicine, Stony Brook University, Stony Brook, NY, USA Q. Zhang Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
Introduction The prevalence of obesity is rapidly increasing in the USA today, with over ten million individuals considered to be morbidly obese. Obesity poses serious public health concerns and is now projected to overtake smoking as the leading cause of death – in the USA.1 3 As a result, the need for and demand of bariatric surgeries have grown exponentially over the past several years. As such, there is a need to train more surgeons in the skills necessary to practice bariatric surgery. Bariatric surgery as a field is technically challenging and requires complex treatment algorithms both preoperatively and postoperatively. It has been recognized that acquiring these complex operative , – skills requires a learning curve of 100 cases,2 4 8 which poses a significant potential risk of morbidity and mortality. With fellowship training however, the learning curve can be attenuated under the guidance of experienced surgeons. This way, complications can be minimized when they begin their own – practices.4 6 As a result, fellowship training in bariatric surgery is now almost a requirement to pursue this field.
J Gastrointest Surg (2015) 19:594–597
There is also the need to identify institutional factors associated with improved outcomes. It has been recognized that highvolume centers and physicians have improved outcomes, and this fact has been utilized to develop the Center of Excellence , , (COE) accreditation criteria.3 9 10 The American College of Surgeons and American Society for Metabolic and Bariatric Surgery have developed and implemented criteria which sets minimum standards for hospitals and surgeons wishing to obtain the , COE accreditation.3 11 Subsequently, COE status was, for a time, thought to be associated with improved outcomes. However, recent studies have shown that these institutions have no better , , – outcomes than other hospitals with equivalent volumes,2 3 9 11 and volume status is still the main driving force for improved outcomes. As we now see more high-volume institutions pursue fellowship training programs in an effort to keep up with the need for more surgeons, the impact of the presence of these trainees on outcomes is yet unclear but needs to be considered. Although the benefit of a bariatric fellowship training program to the trainee is apparent, the impact of such a program on the hospital and the patients it serve remains undefined. As such, the purpose of this study is to examine the effect of bariatric fellowship training program status on perioperative outcomes.
Methods Following Institutional Review Board and Department of Health approval, the New York statewide planning and research cooperative system (SPARCS) administrative data was used to identify 47,342 adult patients (≥18 years of age) in 91 hospitals who underwent bariatric surgery from 2004 to 2010. SPARCS is a comprehensive longitudinal data reporting system, which collects patient-level risk characteristics, treatments, and outcomes for all New York state hospital discharges. Bariatric surgery was identified by discharges with a primary diagnosis of overweight or obesity, and a primary procedure code for laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic gastric band (LGB), and laparoscopic sleeve gastrectomy (LSG). All non-primary procedures and revisional operations were excluded, as well as those patients with incomplete records or age
