Background

In the field of adult metabolic and bariatric surgery (MBS), surgical volume is a known surrogate for quality. However, for adult metabolic and bariatric surgeons who also practice in the pediatric population, it is unclear whether adult MBS experience can be used to predict quality in these younger patients.

Methods

The New York (NY) Statewide Planning and Research Collaborative System was used to extract patients ≤19 years old undergoing a Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) or Sleeve Gastrectomy (SG) from 2010-2016. Surgeon adult MBS volume was categorized as low (≤50), medium (50-150), or high (>150 cases/year). Multivariable analysis adjusting for patient age, sex, race, insurance, obesity-related comorbidities*, calendar year, hospital volume, and clustered at the hospital level, was performed to examine differences in length of stay (LOS), 30-day complications, and readmissions.

Results

A total of 1,057 adolescents ≤19 years old underwent MBS from 2010-2016 in NY state, consisting of 796 (75.3%) SG and 261 (24.7%) LRYGB, performed by 154 surgeons. The mean LOS was 2.0 days, and the overall 30-day complication and readmission rates were 5.4% and 3.6% respectively. On multivariable analysis, medium and high-volume surgeons had 0.3- and 0.4-days shorter LOS when compared to low-volume surgeons (p<0.001 for both), without a corresponding difference in complications or readmissions (Table 1).

Conclusions

Surgeons with high adult MBS volume have shorter LOS for their pediatric patients. These findings represent an important first step in developing clear quality metrics, particularly as the field of pediatric MBS evolves and expands.