Gastric bypass patients fare better as surgical programs' experience increases

CHICAGO Risk of serious complications and death following gastric bypass surgery for morbid obesity may be reduced substantially when the surgery is performed at high volume centers and the surgeons have reached the 100 case experience, according to an article in the April issue of Archives of Surgery, one of the JAMA/Archives journals.

The number of surgical procedures for morbid obesity has increased by 644 percent in the last decade, according to background information in the article. Although laparoscopic Roux-en-Y gastric bypass surgery has been the "gold standard" operative procedure for the treatment of intractable morbid obesity for more than 30 years, it remains a technically difficult operation that is performed on a high-risk patient population. "As most bariatric surgeons are well aware, morbidly obese patients do not tolerate complications," the authors write. "Complications, such as leaks [of the staple line], often result in catastrophic outcomes for these patients."

Scott A. Shikora, M.D., of Tufts-New England Medical Center, Boston, and colleagues analyzed the medical records of 750 consecutive morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass surgery at Tufts-New England Medical Center from March 1998 to April 2004 to evaluate the role of experience and patient volume in reducing the rate of complications in patients undergoing this type of surgery. Eighty-five percent of the patients were female, with a mean age of 41 years. Their body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) ranged from 32 to 86 (a BMI greater than 29.9 is considered obese) with an average BMI of 47.

The overall complication rate was 15 percent with a death rate of 0.3 percent, according to the authors. But for the first 100 cases, the overall complication rate was 26 percent with a death rate of one percent. This complication rate decreased to approximately 13 percent and wa

Contact: Leigh Lucas
JAMA and Archives Journals

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