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Does establishing a bariatric surgery fellowship training program influence operative outcomes?

Gonzalez R, Nelson LG, Murr MM

Interdisciplinary Obesity Treatment Group, Department of Surgery, University of South Florida College of Medicine, c/o Tampa General Hospital, P.O. Box 1289, Tampa, FL 33601, USA.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) has a long learning curve that may be reflected in operative outcomes. This study sought to assess whether training a fellow has an impact on the operative outcomes of the training program. METHODS: Prospectively collected data on 150 consecutive patients were compared before (group 1) and after (group 2) establishment of a fellowship-training program. RESULTS: A greater number of patients underwent laparoscopic RYGB (LRYGB) in group 2 than in group 1 (63% vs 46%; p = 0.01). The group 2 patients were similar to the group 1 patients in terms of age, gender, length of stay, and complication rate. However, they had a higher body mass index (BMI) (median 50 kg/m2; range, 39-64 kg/m2 vs median, 46 kg/m2; range, 38-56 kg/m2; p = 0.01) and a higher incidence of prior abdominal procedures (21% vs 7%; p = 0.006). In addition, operative time was significantly shorter for the patients who underwent open RYGB (ORYGB) (median, 150 min; range, 65-280 min vs median, 110 min; range, 50-210 min; p < 0.001) and LRYGB (median, 202 min; range, 105-450 min vs median, 134 min; range, 50-191 min; p < 0.001) in group 2 than for the patients in group 1. The patients who underwent ORYGB in groups 1 and 2 had similar characteristics and outcomes. Increasing experience with both ORYGB and LRYGB correlated with a decrease in operative times for group 2 (p < 0.001), but not for group 1. CONCLUSION: Establishment of a fellowship program shortens the operative times for both open and laparoscopic RYGB and expands the scope of bariatric practice by compounding the experience of the operating team without increasing complications.

Published 12 December 2006 in Surg Endosc, 21(1): 109-14.
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