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Impact of Centralized Management of Bariatric Surgery Complications on 90-day Mortality.

Abstract : BACKGROUND AND AIMS: The potential benefit of the centralization of Bariatric surgery (BS) remains debated. The aim of this study was to evaluate the impact on 90-day mortality of an innovative organization aiming at centralizing the care of severe postoperative complications of BS. STUDY DESIGN: The centralization of care for postoperative complication after BS was implemented by French Authorities in 2013 in the Nord-Pas-de-Calais Region, France. This unique formalized network (OSEAN), coordinated by 1 tertiary referral center, enrolled all regional institutions performing bariatric surgery. Data were extracted from the medico-administrative database providing information on all patients undergoing BS between 2009 and 2016 in OSEAN (n = 22,928) and in Rest of France (n = 288,942). The primary outcome was the evolution of 90-day mortality before and after the implementation of this policy. Rest of France was used as a control group to adjust the results to improvement with time of BS outcomes. RESULTS: The numbers of primary procedure and reoperations increased similarly before and after 2013 within OSEAN and in Rest of France. The 90-day mortality rate became significantly lower within OSEAN than in the rest of France after 2013 (0.03% vs 0.08%, P < 0.01). This difference was confirmed in multivariate analysis after adjustment to the procedure specific mortality (P < 0.04). The reduction of 90-day mortality was most visible for sleeve gastrectomy. CONCLUSION: The implementation of centralized care for early postoperative complications after BS in OSEAN was associated with reduced 90-day mortality. Our results indicate that this reduction was not due to a lower incidence of complications but to the improvement of their management.
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https://hal.univ-lille.fr/hal-03344892
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Soumis le : mercredi 15 septembre 2021 - 11:43:20
Dernière modification le : mercredi 27 octobre 2021 - 05:25:21

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Robert Caiazzo, Gregory Baud, Guillaume Clement, Xavier Lenne, Fanelly Torres, et al.. Impact of Centralized Management of Bariatric Surgery Complications on 90-day Mortality.. Annals of Surgery, Lippincott, Williams & Wilkins, 2018, Annals of surgery, 268 (5), pp.831-837. ⟨10.1097/SLA.0000000000002949⟩. ⟨hal-03344892⟩

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