Best achievable benchmarks in bariatric surgery: a nationwide registry study

Area of Science:

• Bariatric Surgery
• Surgical Quality Improvement
• Laparoscopic Procedures

Background:

• Bariatric surgery is a common elective laparoscopic procedure with ongoing efforts to enhance standards.
• Establishing reliable benchmarks is crucial for quality assessment in bariatric surgery.

Purpose of the Study:

• To establish aspirational benchmarks for laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG).
• To develop adjusted reference values for patient groups at risk of severe complications.
• To assess current surgical quality in an unselected national cohort.

Main Methods:

• Retrospective cohort study utilizing the Scandinavian Obesity Surgery Registry (2012-2021).
• Employed the Achievable Benchmark of Care methodology to define quality-related outcomes, focusing on severe complications (Clavien-Dindo > II).
• Logistic regression identified risk factors for severe complications; adjusted benchmarks were calculated for relevant subgroups.

Main Results:

• The study included 36,846 LRYGB and 15,246 LSG patients.
• Severe complications occurred in 3.6% of LRYGB cases (benchmark 1.5%) and 1.9% of LSG cases (benchmark 0.4%).
• Risk factors for LRYGB included prior deep vein thrombosis and antidepressant use; for LSG, they included age, BMI, smoking, dyspepsia, and diabetes. Diabetes increased LSG benchmark to 1.2%.

Conclusions:

• Validated national registry data yielded more demanding benchmarks than previous global standards.
• These benchmarks necessitate a re-evaluation of surgical quality in bariatric procedures.
• The findings are expected to drive quality improvement initiatives among bariatric surgery providers.