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

    26 Scopus citations

    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 1 2007

      Fingerprint

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Lautz, D. B., Jackson, T. D., Clancy, K. A., Escareno, C. E., Schifftner, T., Henderson, W. G., Livingston, E., Rogers, S. O., & 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, 204(6), 1261-1272. https://doi.org/10.1016/j.jamcollsurg.2007.04.003