Most recent update: Friday, August 23, 2019 - 09:44

Bariatric News - Cookies & privacy policy

You are here

Mortality and variations

Mortality and variations from UK bariatric operations

Overall in-hospital and 30 day mortality rate remains very low
Variations from 30,000 operations 2009-2013

Since 2009, bariatric surgeons in the UK have report procedure and outcomes data on the national bariatric surgery registry (NBSR) and it relies on self-reported outcomes. A recent publication of consultant reported outcomes by the NBSR indicates an in hospital mortality rate of 0.10%. However, Shivam Bhanderi (College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK) and colleagues wanted to confirm the validity of NBSR reported outcomes and subsequently conducted an analysis on the national Hospital Episodes Statistics (HES) data to confirm the validity of NBSR reported outcomes. The research was presented at the 6th Annual Meeting of the British Obesity and Metabolic Surgical Society 21-23 January, in Newcastle, UK. 

Shivam Bhanderi

The HES database was used to identify all of the patients who had undergone a primary bariatric procedure between 2009 and 2014. OPCS Classification of Interventions and Procedure codes were used to identify all bariatric procedures (gastric bypass, gastric banding, sleeve gastrectomy) but exclude gastrectomy for malignant/ benign disease. In hospital and the Office of National Statistics (ONS) recorded 30-day post-discharge mortality were used as the primary outcome measures.

Some 29,825 primary bariatric procedures were carried out in the NHS between 2009 and 2014. A mean of 5,965 procedures were performed yearly over the five years. There were 28 in-hospital mortalities over the study period (0.094%; 28/29,825) and the overall 30-day post discharge mortality was 0.17% (52/2,9825). There were no significant variations in the in-hospital or 30 day mortality during the study period.

“Despite the continued growth in primary bariatric surgery within England, the overall in-hospital and 30 day mortality rate remains very low. These findings are concordant with the recent surgeon outcome reports from the NBSR and confirm their validity,” said Shivam Bhander. “It furthermore highlights the low risk nature of bariatric surgery. As such, the increased uptake and use of bariatric surgery within the English NHS has been safely facilitated by the offering centres.”

Co-authors of this study were Mushfique Alam1, Jacob Matthews1, David McNulty2, Peter Small3, Domenico Pagano2, Rishi Singhal4, Richard Welbourn5 (1College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK, 2Quality and Outcomes Research Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK, 3Directorate of General Surgery, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK, 4Upper GI & Bariatric Unit, Heart of England NHS Foundation Trust, Birmingham, UK, 5Bariatric Unit, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton, UK)

Variations in practice

“With a global trend for increasing numbers of weight-loss operations each year large national registries help provide for quality assurance and patient safety and to advance the standards of safety and efficacy of bariatric surgery,” said Omar Khan from St George’s Hospital, London, UK. “They also reveal variations in clinical practice that could provide data on helping to improve outcome.”

Omar Khan

Khan and colleagues retrospectively analysed date from 30,925 primary operations from the NBSR including 6,580 (21.3%) adjustable gastric band (AGB), 6,522 (21.1%) sleeve gastrectomy (LSG) and 17,823 (57.6%) Roux-n-Y gastric bypass (RnY). From 2009 to 2013 AGB decreased from 29.9% to 12.5% of performed operations and LSG increased from 8.5% to 28.4%.

Operations done laparoscopically were AGB 99.6%, LSG 99.3% and RnY 91.6%, but increasing from 84.6% (2009) to 98.1% (2013). Recorded re-operation rates for all procedures decreased from 2009-2013: AGB 4.0% - 0.8%, LSG 5.3% - 2.0% and RnY 5.2 % - 3.0%, similarly those staying in hospital 1 night increased for AGB (81.1% – 89.7%) and LSG (45.1% - 66.0%) and two nights for RnY (50.3% - 69.8%).

Individual operative details showed that the pars flacida approach was carried out in 98.8% of AGB procedures; gastro gastric suturing in 92.3% of cases and two bands accounted for 92.7%.

For LSG, staple thickness 1.5mm was 39.5% (56.9% - 33.5%), 1.8mm was 25.3% (17.9% - 32.0%) and 2.0mm 35.2% (25.2% - 34.5%); Use of reinforcement was 57.3% (69.7% - 48.9%), bougie use 96.6%, with 61.6% of procedures using 32-34 Fr.

For bypass, vertical lesser curve pouch was used in 92.8% of procedures (89.4% - 96.4%); GJ anastomosis linear  in 59.7% of cases (39.5% - 70.8%), circular in 20.2% of cases (24.6% - 14.6%), hand sewn 20.1% (34.0% - 14.6%). A JJ anastomosis single stapler was used in 50.0% of cases (35.3% - 61.9%), a triple stapler 31.4% (36.9% - 28.5%) with 94.1 % using a 1.0mm staple thickness; Roux limb placement ante-ante was done in 80.6% of cases (76.7% - 85.4%), retro-ante in 18.2% (21.5% - 13.5%). Limb lengths varied widely with the most frequent a 40-50cm BP limb (29.6%); 100cm or 150cm Roux limb (34.8% & 38.3%). Internal hernia defects were not closed at all  26.8% in of cases, and Petersen’s defects closed in 44%, JJ by 62.5% and mesocolic by 13.9%.

Co-authors of this study were James Hopkins1, Omar Khan3, Peter Small4, Marcus Reddy3, Richard Welbourn2 1University of Southampton, Southampton, UK, 2Musgrove Park Hospital, Taunton, UK, 3St George’s Hospital, London, UK, 4City Hospital, Sunderland, UK

Want more stories like this? Subscribe to Bariatric News!

Bariatric News
Keep up to date! Get the latest news in your inbox. NOTE: Bariatric News WILL NOT pass on your details to 3rd parties. However, you may receive ‘marketing emails’ sent by us on behalf of 3rd parties.