Bariatric Operations in Veterans Affairs and Selected University Medical Centers: Results of the Patient Safety in Surgery Study

David B. Lautz, Timothy D. Jackson, Kerri A. Clancy, Cesar E. Escareno, Tracy Schifftner, William G. Henderson, Edward Livingston, Selwyn O. Rogers, Shukri Khuri

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: The objectives of this study were to evaluate outcomes and predictors of morbidity in patients undergoing Roux-en-Y gastric bypass (RYGB) during the Patient Safety in Surgery (PSS) Study. Study Design: National Surgical Quality Improvement Program data on PSS patients undergoing RYGB were analyzed for unadjusted and adjusted outcomes. Gender groups acted differently and were analyzed separately. Multivariable regression modeling was used to analyze hospital type as a predictor of risk. Stepwise logistic regression was performed to determine patient factors predictive of postoperative morbidity. Results: A total of 2,438 patients (2,064 private sector [PS], 374 Veterans Affairs [VA]) were identified for analysis. Adjusted odds ratio for postoperative morbidity for VA versus PS female patients was 1.14 (95% CI, 0.63-2.05), and for male patients 2.29 (95% CI, 1.28-4.10). Stepwise logistic regression showed that independent risk factors predictive of morbidity were open procedure, higher American Society of Anesthesiologists class, higher body mass index, diabetes, alcohol consumption, leukocytosis, SGOT > 40 U/L, smoking history, and older age. Importantly, male gender was not significant (p = 0.13) in the regression analysis. Subsequent and unrelated to this study, the VA has restructured its bariatric surgical program, including regionalization of centers, with a substantial lowering of associated mortality and morbidity. Conclusions: The VA male subset showed higher risk-adjusted postoperative morbidity compared with the PS male subset. The VA and PS female subsets had equivalent risk-adjusted postoperative morbidity. A systematic approach to quality-improvement processes resulted in improved bariatric surgical outcomes in the VA. Male gender might not be an independent risk factor in RYGB patients.

Original languageEnglish (US)
Pages (from-to)1261-1272
Number of pages12
JournalJournal of the American College of Surgeons
Volume204
Issue number6
DOIs
StatePublished - Jun 2007
Externally publishedYes

Fingerprint

Bariatrics
Veterans
Patient Safety
Private Sector
Morbidity
Gastric Bypass
Quality Improvement
Logistic Models
Leukocytosis
Aspartate Aminotransferases
Alcohol Drinking
Body Mass Index
Smoking
History
Odds Ratio
Regression Analysis
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Bariatric Operations in Veterans Affairs and Selected University Medical Centers : Results of the Patient Safety in Surgery Study. / Lautz, David B.; Jackson, Timothy D.; Clancy, Kerri A.; Escareno, Cesar E.; Schifftner, Tracy; Henderson, William G.; Livingston, Edward; Rogers, Selwyn O.; Khuri, Shukri.

In: Journal of the American College of Surgeons, Vol. 204, No. 6, 06.2007, p. 1261-1272.

Research output: Contribution to journalArticle

Lautz, DB, Jackson, TD, Clancy, KA, Escareno, CE, Schifftner, T, Henderson, WG, Livingston, E, Rogers, SO & Khuri, S 2007, 'Bariatric Operations in Veterans Affairs and Selected University Medical Centers: Results of the Patient Safety in Surgery Study', Journal of the American College of Surgeons, vol. 204, no. 6, pp. 1261-1272. https://doi.org/10.1016/j.jamcollsurg.2007.04.003
Lautz, David B. ; Jackson, Timothy D. ; Clancy, Kerri A. ; Escareno, Cesar E. ; Schifftner, Tracy ; Henderson, William G. ; Livingston, Edward ; Rogers, Selwyn O. ; Khuri, Shukri. / Bariatric Operations in Veterans Affairs and Selected University Medical Centers : Results of the Patient Safety in Surgery Study. In: Journal of the American College of Surgeons. 2007 ; Vol. 204, No. 6. pp. 1261-1272.
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abstract = "Background: The objectives of this study were to evaluate outcomes and predictors of morbidity in patients undergoing Roux-en-Y gastric bypass (RYGB) during the Patient Safety in Surgery (PSS) Study. Study Design: National Surgical Quality Improvement Program data on PSS patients undergoing RYGB were analyzed for unadjusted and adjusted outcomes. Gender groups acted differently and were analyzed separately. Multivariable regression modeling was used to analyze hospital type as a predictor of risk. Stepwise logistic regression was performed to determine patient factors predictive of postoperative morbidity. Results: A total of 2,438 patients (2,064 private sector [PS], 374 Veterans Affairs [VA]) were identified for analysis. Adjusted odds ratio for postoperative morbidity for VA versus PS female patients was 1.14 (95{\%} CI, 0.63-2.05), and for male patients 2.29 (95{\%} CI, 1.28-4.10). Stepwise logistic regression showed that independent risk factors predictive of morbidity were open procedure, higher American Society of Anesthesiologists class, higher body mass index, diabetes, alcohol consumption, leukocytosis, SGOT > 40 U/L, smoking history, and older age. Importantly, male gender was not significant (p = 0.13) in the regression analysis. Subsequent and unrelated to this study, the VA has restructured its bariatric surgical program, including regionalization of centers, with a substantial lowering of associated mortality and morbidity. Conclusions: The VA male subset showed higher risk-adjusted postoperative morbidity compared with the PS male subset. The VA and PS female subsets had equivalent risk-adjusted postoperative morbidity. A systematic approach to quality-improvement processes resulted in improved bariatric surgical outcomes in the VA. Male gender might not be an independent risk factor in RYGB patients.",
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