The Impact of Metabolic and Bariatric Surgeon Status on Outcomes After Bariatric Surgery: a Retrospective Cohort Study Using the MBSAQIP Database.

Abstract

Differences between complication rates of bariatric surgeries performed by general surgeons (GS) versus those performed by metabolic and bariatric surgeons (MBS) are poorly understood. We analyzed the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database focusing on RYGB and SG procedures between 2016 and 2019. Our primary objective was to evaluate trends in the number of bariatric procedures performed by GS and MBS. Secondary objectives were assessing for differences in 30-day mortality and the incidence of serious complications. Differences between groups were evaluated by chi-squared analysis for categorical data and ANOVA tests for continuous data. A multivariable logistic regression was performed to determine the influence of subspecialized training on the incidence of serious complications and 30 day mortality. A total of 622,079 patients were analyzed, 15,485 were operated on by GS (2.5%, mean age 44.7 years, mean BMI 45.2 kg/m2), while 606,594 procedures were performed by MBS (97.5%, mean age 44.4 years, mean BMI 45.2 kg/m2). The proportion of procedures being completed by the GS group decreased from n=4662, 3.2% in 2016, to n=3414, 2.1% in 2019. After adjusting for comorbidities, MBS patients did not have differences in death at 30 days (OR 1.26 [0.67-2.38], p=0.467) or serious complications (OR 0.97 [0.89-1.06], p=0.554). The majority of bariatric procedures are being completed by MBS with the proportion completed by GS decreasing. We found no difference in the number of serious complications and 30-day mortality rates across the MBS and GS groups. Graphical abstract.