Higher hospital and surgeon volumes associated with better outcomes after BMS

Higher hospital and surgeon volumes were associated with lower short-term mortality, fewer complications and shorter hospital stays, after bariatric surgery, according to researchers from Technische Universität Berlin, Berlin, Germany. The association was more pronounced in higher-quality studies. Future research should aim to standardize volume definitions to improve comparability and support policy efforts to centralize care and enhance patient outcomes.

The researchers performed a rapid review of the literature published after 2000, including adult patients (≥18 years) who underwent bariatric surgery for weight loss, or weight loss and diabetes management. The primary outcome was mortality; secondary outcomes included complications, morbidity and hospital stay. Mortality results were stratified by type of mortality and synthesized according to volume type (hospital or surgeon).

In total, 36 studies met the inclusion criteria. Among the included studies, 20 focused on hospital volume, eight on surgeon volume, and eight assessed both hospital and surgeon volume.

The researchers found that perioperative morbidity was significantly related to hospital volume in ten studies. Six studies reported mixed effects, while two studies reported no association. Mixed effects were usually related to analysis of different complications (e.g., specific vs. overall), re-operations or some differing volume. For surgeon volume, three studies found a significant association with perioperative morbidity.

Most studies also linked higher volumes to fewer complications and shorter hospital stays. However, the focus was predominantly on hospital volume and short-term mortality, with limited evaluations of long-term outcomes or weight loss success. Overall study quality varied, with noted limitations including arbitrary volume thresholds.

“Our results suggest better outcomes - specifically lower mortality and complication rates - when surgery is performed at centres and/or by surgeons with higher volumes,” the researchers noted. “This correlation aligns with the ‘practice makes perfect’ hypothesis, which suggests that increased procedural volume enhances technical skills, fosters greater familiarity with complex conditions, and improves the management of complications.”

In addition, high-volume hospitals were more likely to have access to superior resources and infrastructure, as they are more often located in urban areas and tend to attract more referrals and patient visits, factors that further improve outcomes.

“Given that long-term mortality rates following bariatric surgery are generally low, this tendency may adequately capture the relevant mortality risks in the context of bariatric surgery,” they conclude. “Similarly, perioperative and postoperative complications were more frequently analysed and demonstrated improvements with increasing procedural volumes.”

The findings were reported in the paper, 'Volume‒outcome relationships in bariatric surgery: a rapid review', published in the International Journal of Obesity. To access this paper, please click here