BACKGROUND Sleeve gastrectomy is now the most common bariatric operation performed. With lower volumes of Roux-en-Y gastric bypass (RYGB), it is unclear whether decreasing surgeon experience has led to worsening outcomes for this procedure. METHODS We used State Inpatient Databases from Florida, Iowa, New York, and Washington. Bariatric surgeons were designated as those who performed ten or more bariatric procedures yearly. Patients who had RYGB were included in our analysis. Using multi-level logistic regression, we examined whether surgeon average yearly RYGB volume was associated with RYGB patient 30-day complications, reoperations, and readmissions and 1-year revisions and readmissions. RESULTS From 2013 to 2017 there were 27,714 patients who underwent laparoscopic RYGB by 311 surgeons. Median surgeon volume was 77 RYGBs per year. The distribution was 10 bypasses yearly at the 5th percentile, 16 bypasses at the 10th percentile, 38 bypasses at the 25th percentile, and 133 bypasses at the 75th percentile. Multi-level regression revealed that patients of surgeons with lower RYGB volumes had small but statistically significant increased risks of 30-day complications and 1-year readmissions. At 30 days, risk for any complication was 6.71%, 6.43%, and 5.55% at 10, 38, and 133 bypasses per year, respectively (p = 0.01). Risk for readmission at 1 year was 13.90%, 13.67%, and 12.90% at 10, 38, and 133 bypasses per year, respectively (p = 0.099). Of note, volume associations with complications and reoperations due to hemorrhage and leak were not statistically significant. There was also no significant association with revisions. CONCLUSION This is the first study to examine the association of surgeon RYGB volume with patient outcomes as the national experience with RYGB diminishes. Overall, surgeon RYGB volume does not appear to have a large effect on patient outcomes. Thus, patients can safely pursue RYGB in this early phase of the sleeve gastrectomy era.

中文翻译：

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袖状胃切除术时代 Roux-en-Y 胃旁路手术患者的容量-结果关系。

背景袖状胃切除术现在是最常见的减肥手术。由于 Roux-en-Y 胃旁路术 (RYGB) 的体积较小，目前尚不清楚外科医生经验的减少是否会导致该手术的结果恶化。方法 我们使用佛罗里达州、爱荷华州、纽约州和华盛顿州的州住院患者数据库。减肥外科医生被指定为每年进行十次或更多减肥手术的人。患有 RYGB 的患者被纳入我们的分析。使用多级逻辑回归，我们检查了外科医生平均每年的 RYGB 体积是否与 RYGB 患者 30 天并发症、再手术和再入院以及 1 年翻修和再入院相关。结果 从 2013 年到 2017 年，共有 27,714 名患者接受了 311 名外科医生的腹腔镜 RYGB 手术。外科医生手术量中位数为每年 77 RYGB。分布在第 5 个百分位每年有 10 次绕过，在第 10 个百分位有 16 次绕过，在第 25 个百分位有 38 次绕过，在第 75 个百分位有 133 次绕过。多级回归显示，外科医生的 RYGB 体积较小的患者 30 天并发症和 1 年再入院的风险虽然小但具有统计学意义。在 30 天时，任何并发症的风险分别为 6.71%、6.43% 和 5.55%，每年进行 10 次、38 次和 133 次搭桥 (p = 0.01)。一年时再入院的风险分别为 13.90%、13.67% 和 12.90%，每年进行 10 次、38 次和 133 次搭桥 (p = 0.099)。值得注意的是，体积与出血和渗漏引起的并发症和再次手术的相关性没有统计学意义。与修订也没有显着关联。结论 这是第一项研究，随着全国 RYGB 经验的减少，外科医生 RYGB 体积与患者结果之间的关联。总体而言，外科医生 RYGB 体积似乎对患者结果没有太大影响。因此，患者可以在袖状胃切除术时代的早期阶段安全地进行 RYGB。