Background

Bariatric surgical procedures are performed by both General Surgeons (GS) and Minimally Invasive Fellowship-trained (MIS) Surgeons. While there is an increasing focus to consolidate bariatric surgical care to clinical centers of excellence, it is unclear where and to what extent practice patterns and outcomes differ between General and MIS practitioners.

Methods

From the 2017 MBSAQIP database, we identified patients who had metabolic and bariatric surgery by either a General or MIS surgeon. Patient characteristics, perioperative practice patterns and outcomes were compared between study cohorts.

Results

Of 172,430 patients analyzed, 4,394 (2.54%) of procedures were performed by GS. Patients of GS had less comorbidity. GS had higher rates of certain procedural decisions such as staple-line over-sewing (28.61% vs. 21.14%, RR=1.35, p=0.001), postoperative swallow studies (42.33% vs. 31.78%, RR=1.33, p=0.001), and surgical drain placement (18.18% vs. 16.59%, RR=1.1, p=0.005). Overall, complications were low in both groups. While GS had higher rates of readmission (4.46% vs. 3.67%, RR=1.21, p=0.006), there was no difference in overall 30-day morbidity rates between specialties (5.53% vs. 4.93%, RR=1.12, p=0.068). GS had lower rates of infectious complications (0.86% vs. 1.42%, RR=0.61, p=0.002) but higher rates of noninfectious complications (2.37% vs. 1.9%, RR=1.24, p=0.027) (Table 1).

Conclusions

Bariatric surgery can be performed safely by both MIS and General surgeons. There are significant differences in patient selection and perioperative conduct between GS and MIS surgeons. Further research and larger cohorts are needed to determine how these differences may impact outcomes.