Higher rates of postoperative complications following bariatric surgery appear to be closely linked to the skill and experience of the surgeons as rated by their peers, according to the findings of new research.
In a study published this week by the New England Journal of Medicine, researchers used the Michigan Bariatric Surgery Collaborative (MBSC) to rate bariatric surgeons, finding that surgeons who had the lowest ratings were associated with higher percentages of complications and higher mortality rates following the weight loss procedures.
The statewide peer rating included 20 surgeons in Michigan who were given videos of other surgeons and asked to rate them based on skill, one as the lowest and five as the most advanced skill. The peers ranked other surgeons based on technical skill during surgery, resulting in rankings ranging from 2.6 to 4.8.
Surgeons ranked in the lowest quartile had a 14.5% rate of complication, compared to 5.2% in more skilled surgeons. The less skilled surgeons also had mortality rates five times higher than the most skilled surgeons.
The lowest rated surgeons were associated with longer operations. On average, surgeons in the lowest quartile of skill had operations lasting approximately 137 minutes, compared to 98 minutes for surgeons ranked in the highest quartile of skill.
The findings of the study suggest that unskilled surgeons may be three times more likely to have bariatric surgery complications than more skilled surgeons, as ranked by their peers.
The most unskilled surgeons also had higher rates of re-operation and readmission to the hospital compared to the more skilled surgeons.
No identifying markers of the patient or the surgeon were revealed in the videos to keep identities anonymous. Surgeons were videotaped performing laparoscopic gastric bypass and were rated based on gentleness, tissue exposure, instrument handling, flow of operation and time and motion.
Videos were issued and rated every two weeks between July 2011 and June 2012. John D. Birkmeyer, MD, from the University of Michigan Center for Healthcare Outcomes and Policy in Ann Arbor and study co-authors assessed the relationships between skill ratings and risk adjusted complication rates.
Bariatric Surgery Concerns
Researchers were surprised to see such a direct correlation between skill and surgical complications. However, bariatric surgery has gained a slew of media attention as recent studies reveal more risks related to the procedure.
Prior research has highlighted the risk of severe complications from bariatric surgeries, such as gastric bypass and duodenal surgery. The procedures have been linked to problems like malnutrition, vision problems, and vitamin deficiencies. Side effects of sudden and drastic weight loss include deficiencies in calcium and vitamins which can weaken bones, cause iron deficiencies and possibly induce night blindness, researchers found.
Other complications following bariatric surgery include more extreme cases. Last year a British woman choked to death on a backlog of food built up in her esophagus following gastric bypass surgery. The death, while a rarity, highlights the dangers associated with bariatric surgery.
Another danger involved with bariatric surgery is a heightened use of prescription opioids following surgery. A study published last week in the Journal of the American Medical Association (JAMA) revealed patients who underwent bariatric surgery and regularly used prescription opioids, often increase use in the years following their surgeries.