Statistically, which bariatric surgeon would be the safest and have the best surgical outcomes? What characteristics do these surgeons possess? What do their daily tasks tell us? These questions are difficult to answer as they involve many factors from patient’s health and specialist expertise to expected outcomes and many other complex issues.
An acceptable answer is, simply, these questions are unknowable. There has yet to be a definitive study matching surgical outcomes to specific principles and characteristics. However, a large collection of data already exists which compares many different factors to a surgeon’s performance and outcome.
To have the best outcomes on ‘complex’ and ‘risky’ surgeries, such as bariatric surgery, cancer, and thoracic operations, knee and hip replacements and others, surgeons who incorporate or embody the following eight criteria listed below, have the highest chance of successful surgery.
Eight Factors of Surgical Criteria for Excellent Patient Outcomes
- High-Volume Surgeons vs. Low-Volume Surgeons
- Surgeons operate Daily
- Time When Surgery is Performed
- Volume of Surgeries Performed Daily
- Enough Sleep (+6 Hours /Night)
- Volume of procedures on Weekdays/Weekends Limited
- Surgeons’ Vacation/Time Off
- Perform at a High-Volume Hospital – Dedicated to Surgery
1. High-Volume Surgeons
Surgeons who frequently perform bariatric surgeries and are dedicated to bariatrics (high- & medium-volume) have better outcomes than low-volume surgeons or the ones who do not regularly perform the surgery. It seems that practice does make perfect, but this rule is even further enforced by complex and risky operations.
One recent finding in an analysis of Medicare data by the U.S. News & World Report was high-volume surgeons showed confidence, specifically, that high-volume surgeons’ hands were ‘fluid and confident.’ While low-volume surgeons’ hands were ‘herky-jerky.’ This report has lead three leading teaching hospitals – Dartmouth, Johns Hopkins, and the University of Michigan – to limit those who can perform ‘risky’ surgeries, including bariatric, to those who are ‘experienced, proficient surgeons.’
Another study found that high-volume gynecologic laparoscopic specialists had lower complication rates and faster recovery times than low-volume specialists. High-volume surgical experts were described as performing 47 low-complexity, 439 intermediate-complexity, and 93 high-complexity procedures cumulatively. While, low-volume surgeons were described as only performing five low-complexity, ten intermediate-complexity, and 1 high-complexity cumulatively.
The American Society for Metabolic and Bariatric Surgery (ASMBS) criteria for “Centers of Excellence” certification of the hospital or institution is at least 125 bariatric surgeries per year collectively – each surgeon must have operated at least 125 bariatric surgeries and perform at least 50 per year.
Volume alone doesn’t paint the full picture. Patients were operated on should look for surgeons who have a strong track record of performing surgeries with consistency.
2. Surgeons Perform Daily
Recent studies have suggested that surgeons should perform operations daily, or, at least, they should be performing consistently. For instance, taking just one day off can hurt overall surgical success rates, especially if this happens frequently. Another study found suggested surgeons who specialize in one field, was positively correlated with better surgical outcomes.
3. Daily/Weekly Schedules
According to research, surgical experts should plan their surgery schedules for the morning.
Another way to improve patient outcomes and reduce patient risks and complications is to perform operations between 9 AM to 12 PM, as they resulted in the lowest anesthetic-related complications. Having surgery later in the day, starting at 3 PM, 4 PM, & 5 PM had higher levels of anesthetic-related complications. Having surgeons who are dedicated to performing surgeries in the morning will help overall patient outcomes.
Even though high-volume surgeons, who perform daily are desirable, overworked doctors can have drastic effects on the surgeon’s surgical outcomes. Doctors require adequate rest, and their stress levels must be monitored. Furthermore, a review of research has led us to believe that setting caps on a surgeon’s daily volume would result in better patient outcomes.
4. Capped Daily Volume
While the best bariatric surgeons are typically those who perform high-volume, daily and in the morning, evidence suggests doctors who cap their daily surgical limit are able to consistently perform at their best. Operating limited surgeries per day, while still doing it in volume, will lead to better patient outcomes because surgeons can increase rest time and working memory capacity while decreasing stress and fatigue.
Surgeons who are performing dozens of surgeries per week will inevitably struggle with maintaining proper sleep schedules, which is why capping daily operations is imperative. Surgeons who get less than 6 hours of sleep per night are likely to exhibit an increased risk of surgical complications.
One study reports that sleep-deprived physicians were 300% more likely to make fatigue-related medical errors, leading to a patient’s deaths. Clearly, one of the best ways to increase patient outcomes and satisfaction is to have a well-rested surgeon.
6. Working Memory Capacity
One study suggests that physicians who work longer hours are more prone to have a reduced working memory capacity or WMC. Reduced working memory has been associated with lower recall rates and higher test errors. Surgeons who schedule throughout the week should facilitate mental recovery, and therefore, less decrease in WMC.
Another related factor is how long work hours are putting patients at risk. In a review of Emergency Medicine Physicians, it was noted that high work-related hours were associated with burnout. Burnout can lead to greater depression, higher dissatisfaction, and stress.
Research by the American Society for Bariatric Surgery recently examined how well surgery centers perform. Their research showed that hospitals that performed 100 bariatric cases annually played much better than hospitals that performed fewer than 100 cases. In fact, 100 cases annually were associated with patients facing ‘shorter length of stay, lower morbidity, and mortality and decreased costs.’
More interestingly, patients older than 55 had even better outcomes. Patients older than 55, were observed to face 3 times the mortality rate at low-volume hospitals than high-volume hospitals. These findings suggest that not only does the surgeon matter, but the hospital where one undergoes weight-loss surgery matters when measuring outcomes.
With hospital staff more accustomed to bariatrics, they will likely have better cohesion and understanding of the surgery being performed. By attending a hospital that performs surgery in volume, patients will likely experience a greater outcome.
Ideally, the best results stem from hospitals and surgeons who are high-volume. Simultaneously, these surgeons should also follow a schedule of performing daily and capping their daily surgeries to rest and for mental recovery.
While outcomes of operations cannot be guaranteed, these principles are aimed to predict any surgical outcome. These principles should not be taken as limiting principles; patients need not overlook the general consideration of the surgeon. Which includes their experience, education, and training.
Surgical volume has a direct correlation with surgical mortality and success. Experienced surgeons regularly performing surgeries in the earlier part of the day with a limited number of operations per day have less surgical mortality and better outcomes. Other factors that contribute to lower surgical risks include performing procedures during the week and undergoing surgery at a high-volume hospital that is dedicated to a specific operation.
About Mexico Bariatric Center
Mexico Bariatric Center is dedicated to an evidence-driven, best-practice healthcare company, which strives to create the highest patient outcomes as possible. We’ve found that these eight criteria can be hard to implement, but we’ve seen incredible results from them.
Mexico Bariatric Center® (MBC) offers inexpensive weight-loss surgeries in Mexico, from the gastric sleeve, gastric bypass, mini bypass, duodenal switch, gastric banding, and gastric plication. MBC is a scheduling facilitator and not a hospital.
Mexico Bariatric Center is offering:
Nguyen, Ninh, Mahbod Paya, C. Stevens, Shahrzad Mavandadi, Kambiz Zainabadi, and Samuel Wilson. “The Relationship Between Hospital Volume and Outcome in Bariatric Surgery at Academic Medical Centers.” Annals of Surgery. U.S. National Library of Medicine. Web. 15 July 2015.
Gohar, Ashraf, Alexander Adams, Elie Gertner, Linda Sackett-Lundeen, Richard Heitz, Randall Engle, Erhard Haus, and Jagdeep Bijwadia. “Working Memory Capacity Is Decreased in Sleep-Deprived Internal Medicine Residents.” Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine. American Academy of Sleep Medicine. Web. 15 July 2015.
“Study Says Surgeons Should Never Take a Day off.” Https://www.themedicalbag.com/doctor-blogs/skeptical-scalpel/study-says-surgeons-should-never-take-a-day-off. 21 July 2014. Web. 15 July 2015.
Henry Ford Health System. “Hospital surgical volume should be considered when judging the value of procedures.” ScienceDaily. ScienceDaily, 5 May 2013. <www.sciencedaily.com/releases/2013/05/130505145800.htm>.
Worley MJ Jr1, Anwandter C, Sun CC, dos Reis R, Nick AM, Frumovitz M, Soliman PT, Schmeler KM, Levenback CF, Munsell MF, and Ramirez PT.”Surgeon Volume on Laparoscopic Surgery.” National Center for Biotechnology Information. U.S. National Library of Medicine, 10 Jan. 2012. Web. 15 July 2015.
Hutter, Matthew, Katherine Kellogg, Charles Ferguson, William Abbott, and Andrew Warshaw. “The Impact of the 80-Hour Resident Workweek on Surgical Residents and Attending Surgeons.” Annals of Surgery. U.S. National Library of Medicine. Web. 15 July 2015.
Julie A. Freischlag. “Long Hours Put Surgeons, Patients at Risk, Study Suggests.”Hopkins Medicine. Johns Hopkins and Mayo Clinic. Web. 15 July 2015.
Lockley SW1, Barger LK, Ayas NT, Rothschild JM, Czeisler CA, Landrigan CP; Harvard Work Hours, and Health and Safety Group. “Work Hours, Sleep Deprivation on Safety and Performance.”National Center for Biotechnology Information. U.S. National Library of Medicine, 1 Nov. 2007. Web. 15 July 2015.
Bendavid E1, Kaganova Y, Needleman J, Gruenberg L, and Weissman JS. “Complication rates on weekends and weekdays in US hospitals.” National Center for Biotechnology Information. U.S. National Library of Medicine, 1 May 2007. Web. 15 July 2015.
Rothschild JM1, Keohane CA, Rogers S, Gardner R, Lipsitz SR, Salzberg CA, Yu T, Yoon CS, Williams DH, Wien MF, Czeisler CA, Bates DW, and Landrigan CP. “Risks of Complications by Attending Physicians after Performing Nighttime Procedures.” National Center for Biotechnology Information. U.S. National Library of Medicine, 14 Oct. 2009. Web. 15 July 2015.
Arora M1, Asha S, Chinnappa J, and Diwan AD. “Review Article: Burnout in Emergency Medicine Physicians.”National Center for Biotechnology Information. U.S. National Library of Medicine, 25 Dec. 2013. Web. 15 July 2015.