• Daniel Gero, Dimitri A Raptis, Wouter Vleeschouwers, Sophie L van Veldhuisen, Andres San Martin, Yao Xiao, Manoela Galvao, Marcoandrea Giorgi, Marine Benois, Felipe Espinoza, Marianne Hollyman, Aaron Lloyd, Hanna Hosa, Henner Schmidt, José Luis Garcia-Galocha, Simon van de Vrande, Sonja Chiappetta, Menzo Emanuele Lo EL The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL., Cristina Mamédio Aboud, Sandra Gagliardo Lüthy, Philippa Orchard, Steffi Rothe, Gerhard Prager, Dimitri J Pournaras, Ricardo Cohen, Raul Rosenthal, Rudolf Weiner, Jacques Himpens, Antonio Torres, Kelvin Higa, Richard Welbourn, Marcos Berry, Camilo Boza, Antonio Iannelli, Sivamainthan Vithiananthan, Almino Ramos, Torsten Olbers, Matias Sepúlveda, Eric J Hazebroek, Bruno Dillemans, Roxane D Staiger, Milo A Puhan, Ralph Peterli, and Marco Bueter.
• Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
• Ann. Surg. 2019 Nov 1; 270 (5): 859-867.

ObjectiveTo define "best possible" outcomes for bariatric surgery (BS)(Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]).BackgroundReference values for optimal surgical outcomes in well-defined low-risk bariatric patients have not been established so far. Consequently, outcome comparison across centers and over time is impeded by heterogeneity in case-mix.MethodsOut of 39,424 elective BS performed in 19 high-volume academic centers from 3 continents between June 2012 and May 2017, we identified 4120 RYGB and 1457 SG low-risk cases defined by absence of previous abdominal surgery, concomitant procedures, diabetes mellitus, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, anticoagulation, BMI>50 kg/m and age>65 years. We chose clinically relevant endpoints covering the intra- and postoperative course. Complications were graded by severity using the comprehensive complication index. Benchmark values were defined as the 75th percentile of the participating centers' median values for respective quality indicators.ResultsPatients were mainly females (78%), aged 38±11 years, with a baseline BMI 40.8 ± 5.8 kg/m. Over 90 days, 7.2% of RYGB and 6.2% of SG patients presented at least 1 complication and no patients died (mortality in nonbenchmark cases: 0.06%). The most frequent reasons for readmission after 90-days following both procedures were symptomatic cholelithiasis and abdominal pain of unknown origin. Benchmark values for both RYGB and SG at 90-days postoperatively were 5.5% Clavien-Dindo grade ≥IIIa complication rate, 5.5% readmission rate, and comprehensive complication index ≤33.73 in the subgroup of patients presenting at least 1 grade ≥II complication.ConclusionBenchmark cutoffs targeting perioperative outcomes in BS offer a new tool in surgical quality-metrics and may be implemented in quality-improvement cycle.ClinicalTrials.gov Identifier NCT03440138.

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