Relationship Between Provider Volume and Postoperative Complications for Bariatric Procedures in New York State

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Abstract
Although the number of bariatric procedures has grown recently, few studies have focused on the relationship between provider volume and outcomes among patients undergoing a bariatric procedure. Using New York State's inpatient discharge database, we identified adults undergoing a bariatric procedure in New York State between January 1, 2003 and December 31, 2003 (n=7,868). Separate multivariable statistical models were constructed to examine the relationship between surgeon volume and hospital volume and postoperative complications (using surgeon volume cutpoints of 25, 50, 100, 150 and hospital volume cutpoints of 100, 125, 150, 200) while controlling for demographic characteristics and comorbidity. There was a considerably higher likelihood of postoperative complications among surgeons performing 100 or fewer bariatric procedures compared with those performing more than 100 procedures (odds ratio [OR]: 2.39, 95% CI: 1.59 to 3.59) and for those performing 150 or fewer procedures compared with those performing more than 150 procedures (odds ratio: 2.05, 95% CI: 1.29 to 3.25) after risk adjustment. Likewise, for each of the four hospital volume cutpoints, there was a notably higher likelihood of postoperative complications in the lower volume hospitals. Analyses of the interaction between surgeon and hospital volume indicated a markedly higher likelihood of postoperative complications among patients operated on by a low-volume surgeon (100 procedures or fewer) in a low-volume hospital (150 procedures or fewer) or a low-volume surgeon in a high-volume hospital than among patients operated on by a high-volume surgeon in a high-volume hospital. The likelihood of postoperative complications from bariatric procedures is greater for patients with low-volume surgeons or in low-volume hospitals.