Document Detail


Characterizing the performance and outcomes of obesity surgery in California.
MedLine Citation:
PMID:  14570356     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Between 1991 and 2000, the prevalence of obesity increased 65 per cent. As a result, increasing research is being directed at gastric bypass (GB) surgery, an operation that appears to achieve long-term weight reduction. Despite the rapid proliferation of this surgery, the quality of care at a population level is largely unknown. This study examines longitudinal trends in quality and identifies significant predictors of adverse outcomes. Using the California inpatient discharge database, all GB operations from 1996 to 2000 were identified. Demographic, comorbidity, complication, and volume data were obtained. Complications were defined as life-threatening cardiac, respiratory, or medical (renal failure or shock) events. Comorbidity was graded on a modified Charlson score. Annual hospital volume was categorized into four groups: < 50, 50-99, 100-199, and 200+ cases. Based on these data, we calculated longitudinal trends in complication rate and performed logistic regression to identify predictors of complications. A total of 16,232 patients were included. The average age was 41 years; 84 per cent were female, and 83.5 per cent were white. The complication rate was 10.4 per cent. Between 1996 and 2000, rates of cardiac and respiratory complications decreased while rates of medical complications remained unchanged. Complications were more likely in men [odd ratio (OR) = 1.69 compared to women] and in patients with comorbidities (OR = 1.60 for each additional comorbid disease). Furthermore, when examining the effect of volume, patients at very low (< 50) and low (50-99) volume hospitals were much more likely to have complications (OR = 2.72 and 2.70, respectively) compared to patients at high-volume hospitals (200+), even after controlling for differences in case-mix. The quality of care for obesity surgery has improved between 1996 and 2000. Despite operating on patients with more comorbidity, rates of cardiac and respiratory complications have decreased. Furthermore, this study identifies three independent predictors of complications: gender, comorbidity, and hospital volume. These findings are important initial steps toward improving quality in obesity surgery.
Authors:
Jerome H Liu; David Zingmond; David A Etzioni; Jessica B O'Connell; Melinda A Maggard; Edward H Livingston; Carson D Liu; Clifford Y Ko
Related Documents :
3959246 - Chronic scrotal hypothermia: results in 90 infertile couples.
16725856 - Fertility on synchronized estrus in crossbred (bos taurus x bos indicus) heifers.
7744476 - Morbidity and mortality for elderly patients with fractured neck of femur treated by he...
709086 - Amoebic perforation of the bowel: experiences with 26 cases.
7586466 - Unilateral versus bilateral internal mammary revascularization. survival and event-free...
21931086 - Tensile characteristics of costal and septal cartilages used as graft materials.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  69     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-10-22     Completed Date:  2003-11-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  823-8     Citation Subset:  IM    
Affiliation:
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
California / epidemiology
Comorbidity
Female
Gastric Bypass* / statistics & numerical data,  trends
Hospitals / statistics & numerical data
Humans
Logistic Models
Longitudinal Studies
Male
Obesity, Morbid / epidemiology
Outcome Assessment (Health Care)
Postoperative Complications / epidemiology*
Prevalence
Quality of Health Care

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Gangrenous appendicitis in a strangulated obturator hernia.
Next Document:  Appendiceal abscess: immediate operation or percutaneous drainage?