Which bariatric surgeon would be the safest and have the best surgical outcomes? What characteristics do these surgeons possess? What does their daily load 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.
Published data suggest that a high-volume center, like Mexico Bariatric Center®, improves operative outcomes and recovery. The expertise and experience of the surgical teams and the ability of the hospital staff to provide high-quality care for morbidly obese patients contribute to the low complication rate (<1%).
To have the best outcomes on ‘complex’ and ‘risky’ surgeries, such as bariatric surgery, cancer, thoracic operations, and knee and hip replacements, surgeons who incorporate or embody the following eight criteria listed below have the highest chance of successful surgery.
Eight Factors Affecting Bariatric Patient Outcomes
Here are eight surgical criteria for satisfactory postoperative results and recovery,
- High-Volume Surgeons vs. Low-Volume Surgeons
- Surgeons operate Daily
- Time When Surgery is Performed
- Number of Surgeries Performed Daily
- Enough Sleep (+6 Hours /Night)
- Limited procedures on Weekdays/Weekends
- 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 have better outcomes than surgeons who do not regularly perform the surgery. It seems that practice makes perfect, but complex and risky operations even further enforce this rule.
One recent finding in an analysis of Medicare data by the U.S. News & World Report was that high-case volume surgeons showed confidence; specifically, the surgeons’ hands were ‘fluid and confident,’ while low-volume surgeons’ hands were ‘herky-jerky.’ This report has led 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 intraoperative and postoperative complication rates as well as faster recovery times than low-volume specialists. High-volume surgical experts were described as carrying out 47 low-complexity, 439 intermediate-complexity, and 93 high-complexity procedures cumulatively. At the same time, 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.
The quantity of operations alone doesn’t paint the full picture. Patients undergoing surgery should look for doctors with a strong track record of continuous operations.
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 suggested surgeons specializing in one field were positively correlated with more satisfactory surgical outcomes. Surgeons practicing in multiple locations increase the chance of adverse effects on the operation.
3. Daily/Weekly Schedules
According to research, surgical experts should plan their surgery schedules for the morning.
Another way to improve patient satisfaction and reduce patient risks and complications is to perform operations between 9 AM to 12 PM, as they result 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 physicians who are scheduled to perform 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 numbers 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 perform at their best consistently. Managed operations per day while still doing it in large numbers will lead to prolonged survival rates because surgeons can increase rest time and working memory capacity while decreasing stress and fatigue.
5. Rest
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 death. 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 working longer hours are more prone to reduced working memory capacity (WMC). Sleep deprivation has been associated with impaired judgment, lower recall rates, higher clinical errors, and adverse events. Surgeons with heavy weekly work schedules should facilitate mental recovery, and therefore, less decrease in WMC.
Working Memory Capacity (WMC) is also influenced by various factors including age, sex, and education. As individuals grow older, there is a decline in cognitive ability. When performing minimally invasive surgeries, good hand-eye coordination is critical and age becomes a significant factor.
Mexico Bariatric Center has the edge over most U.S.-based surgical teams as their surgeons are typically around 40 years old and possess a higher WMC. One reason for this is that in Mexico, surgeons begin to learn about surgical techniques at a younger age, whereas in the U.S., they will not get the same opportunity until later in life. As a result, surgeons in the U.S. tend to be older than their Mexican counterparts.
7. Stress/Burnout
Another related factor is long hours and extended shifts. Working more than 80 hours per week causes surgical team distress, putting patients at risk.
A review of Emergency Medicine Physicians noted that high work-related hours were associated with burnout. Burnout can lead to greater depression, higher dissatisfaction, stress, and medical errors.
8. Hospitals
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 a lower length of hospital stay, 30-day readmission, morbidity and mortality, and 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 at high-volume hospitals. These findings suggest that the surgeon and the hospital where one undergoes weight-loss surgery matter when measuring outcomes and recovery.
With hospital staff more accustomed to bariatrics, they will likely have superior cohesion and understanding of the surgery being performed. By attending a hospital that performs surgery in volume, patients will likely experience a greater outcome.
Conclusion
The most desirable results stem from high-case volume clinical institutions and surgeons. Surgical volume has a direct correlation with surgical morbidity and mortality. Experienced clinicians regularly operating earlier in the day with a limited number of procedures per day have less surgical mortality and excellent outcomes.
Surgeons should follow a work schedule of performing every day and capping their daily surgeries to rest and for mental recovery.
While outcomes of operations cannot be guaranteed, these principles are aimed at predicting 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, training, and accreditation.
Other factors contributing to lower surgical risks include choosing a high-volume hospital dedicated to a specific operation.
About Mexico Bariatric Center
Mexico Bariatric Center® (MBC) provides inexpensive weight-loss surgeries in Mexico, from the endo-sleeve, gastric balloon, gastric sleeve, gastric bypass, mini bypass, duodenal switch, gastric banding, and gastric plication. MBC is a scheduling facilitator and not a medical facility.
MBC is dedicated to an evidence-driven, best-practice healthcare company that strives to create the highest patient outcomes possible. We’ve found that these eight parameters can be hard to implement, but we’ve seen incredible results from them.
Mexico Bariatric Center is offering:
References:
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.
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