The impact of hospital volume on metabolic and bariatric surgery outcomes

Metabolic and bariatric surgery (MBS) is an effective treatment for severe obesity. Prior research suggests a volume-outcome relationship, where higher hospital volumes correlate with improved patient safety. However, current accreditation standards may not reflect contemporary practice.

To evaluate the impact of hospital volume on postoperative complications, as measured by Patient Safety Indicators (PSI-90), and mortality following bariatric surgery.

Nationwide Readmissions Database (NRD) from 2018 to 2020, representing 266,743 procedures across 1947 U S. hospitals.

Bariatric procedures (sleeve gastrectomy (SG), gastric bypass (GP), and duodenal switch (DS)) were categorized into low-, medium-, and high-volume hospitals based on tertiles of case volume. Risk-adjusted odds ratios (ORs) for PSI-90 complications and mortality were compared using high-volume centers as the reference.

Medium-volume centers had significantly increased risk of PSI-90 complications for SG (OR 1.56, P < .001) and DS (OR 2.16, P = .035) compared to high-volume hospitals. No significant difference was found between low- and high-volume hospitals, suggesting patient selection bias at low-volume centers. GP outcomes did not significantly vary across volume tiers.

Higher hospital volume was associated with reduced postoperative complications for SG and DS. The increased complication risk in medium-volume centers suggests the need to reassess accreditation volume thresholds. Future policies should ensure standards align with evolving bariatric surgical practices to optimize patient outcomes.