Best achievable benchmarks in bariatric surgery: a nationwide registry study

Bariatric surgery is currently one of the most performed elective laparoscopic procedures. Continuous refinement elevates standards.

This retrospective cohort study aimed to determine aspirational benchmarks for laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) in an unselected cohort, developing adjusted reference values for groups at risk of severe complications.

Nationwide registry study including every bariatric facility in Sweden.

Using data from the Scandinavian Obesity Surgery Registry encompassing Swedish primary LRYGB and LSG procedures from 2012 to 2021, the Achievable Benchmark of Care methodology was employed to establish reference values for quality-related surgical outcomes, notably severe complications. The data included perioperative and postoperative data up to 30 days after surgery. Logistic regression identified risk factors for severe complications (Clavien-Dindo > II). Adjusted benchmarks were developed for relevant subgroups using the Achievable Benchmark of Care methodology.

The study included 36,846 LRYGB and 15,246 LSG patients. Severe postoperative complications occurred in 3.6% (interquartile range: 2.5%-5.1%) of LRYGB cases, with a benchmark of 1.5%. Risk factors included prior deep vein thrombosis and ongoing antidepressant use. In the LSG group, 1.9% (interquartile range: .5%-3.7%) experienced severe complications, compared to a benchmark of .4%. Risk factors encompassed age, body mass index, smoking, dyspepsia, and diabetes. Only diabetes in the LSG group increased the benchmark to 1.2% for severe complications.

These benchmarks, developed from validated national registry data, are more demanding than previous global benchmarks. They prompt reflection on surgical quality and will hopefully inspire further quality improvement initiatives across bariatric surgery providers.