Objective To determine whether perioperative outcomes differ between patients undergoing concurrent compared with non-concurrent bariatric operations in the USA. Design Retrospective, propensity score matched cohort study. Setting Hospitals in the US accredited by the American College of Surgeons' metabolic and bariatric surgery accreditation and quality improvement program. Participants 513 167 patients undergoing bariatric operations between 1 January 2014 and 31 December 2016. Main outcome measures The primary outcome measure was a composite of 30 day death, morbidity, readmission, reoperation, anastomotic or staple line leak, and bleeding events. Operative duration and lengths of stay were also assessed. Operations were defined as concurrent if they overlapped by 60 or more minutes or in their entirety. Results In this study of 513 167 operations, 739 (29.5%) surgeons at 483 (57.8%) hospitals performed 6087 (1.2%) concurrent operations. The most frequently performed concurrent bariatric operations were sleeve gastrectomy (n=3250, 53.4%) and Roux-en-Y gastric bypass (n=1601, 26.3%). Concurrent operations were more often performed at large academic medical centers with higher operative volumes and numbers of trainees and by higher volume surgeons. Compared with non-concurrent operations, concurrent operations lasted a median of 34 minutes longer (P<0.001) and resulted in 0.3 days longer average length of stay (P<0.001). Perioperative adverse events were not observed to more likely occur in concurrent compared with non-concurrent operations (7.5% v 7.4%; relative risk 1.02, 95% confidence interval 0.90 to 1.15; P=0.84). Conclusions Concurrent bariatric operations occurred infrequently, but when they did, there was no observable increased risk for adverse perioperative outcomes compared with non-concurrent operations. These results, however, do not argue against improved and more meaningful disclosure of concurrent surgery practices.
Bibliographical noteFunding Information:
Contributors: JBL conceived the project and its design; acquired, analyzed, and interpreted the data; and prepared the first draft of this manuscript and led its critical revisions. BLH and CYK conceived the project and its design; acquired and interpreted the data; and contributed critical revisions to the manuscript. KAB, JRB, KMF, YL, and DBH acquired, analyzed, and interpreted the data and contributed critical revisions to the manuscript. All authors have granted final approval of the version to be published and assume accountability as individuals for the final manuscript and its contents. JBL is guarantor. Funding: This study was funded by the American College of Surgeons (ACS). The ACS had a role in the design and conduct of the study; collection, management, and interpretation of the data; preparation, review, and approval of the manuscript; and, the decision to submit the manuscript for publication because all coauthors, except MMH, are affiliated with the ACS. However, this work represents the conclusions of the authors only and is not intended as a policy statement of the ACS as an organization.
disclosure form (available on request from the corresponding author) at www.icmje.org/coi_disclosure.pdf and declare: JBL receives funding from the Department of Surgery, University of Chicago Medicine under the auspices of Jeffrey B Matthews for work unrelated to the submitted work, JRB receives funding from the John A Hartford Foundation for work unrelated to the submitted work, KAB receives funding from the Agency for Healthcare Research and Quality for work unrelated to the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; all authors are affiliated with the American College of Surgeons.