Textbook Outcome in Bariatric Surgery: Evolution During 15 Years in a Referral Center.

BACKGROUND: Textbook outcome (TO) is a multidimensional measure used to assess the quality of care. It is the "ideal" surgical result, based on a series of established indicators. In the field of bariatric surgery (BS), only one publication on TO is available. OBJECTIVES: To determine TO in our BS unit and identify the factors linked to TO. SETTING: University public hospital in Alicante (Spain). METHODS: Retrospective observational study of all primary BS was performed. TO for BS was defined in relation to the following features: no major postoperative complications (Clavien-Dindo >II), hospital stay <75th percentile, and no mortality or readmissions within 30 days of surgery. Comparative analysis of the characteristics of the TO and non-TO groups was performed, as well as univariate and multivariate logistic regressions, to identify the independent factors associated with obtaining TO. RESULTS: In 970 patients, TO was achieved in 71.5%. The hospital stay was the one that most affected achievement of TO. Analysis according to the type of procedure (sleeve gastrectomy and gastric bypass) did not reveal any differences between both procedures in terms of obtaining TO (71.5 vs 71.26%). Logistic regression identified smoking, heart disease, operative time, and upper gastrointestinal bleeding as independent factors associated with obtaining TO (p<0.05). Analysis of the annual evolution of TO reveals a progressive increase in its achievement (7.7-86.4%). CONCLUSION: In our series, TO was obtained in 71.5% of patients. The standardization of the technique and the experience gained over the years has improved our TO results.

Textbook outcome en cirugía gástrica oncológica, ¿qué implicaciones tiene sobre la supervivencia? / Textbook outcome in gastric surgery, what implications does it have on survival?

Introducción: El textbook outcome (TO), o resultado de libro, es una medida multidimensional para evaluar la calidad de la práctica asistencial. Ésta viene reflejada como el resultado quirúrgico «ideal», atendiendo a una serie de indicadores o puntos de referencia establecidos que se adaptan en función de la patología quirúrgica que queramos analizar. Son pocas las referencias bibliográficas y las series publicadas al respecto, todas ellas muy recientes. Objetivo: Valorar el grado de cumplimiento del TO y su impacto sobre la supervivencia. Método: Estudio observacional retrospectivo de todas las neoplasias gástricas intervenidas en nuestro centro. Periodo: desde enero del 2015 hasta diciembre del 2020. Se determinaron los siguientes criterios TO: márgenes R0, > 15 ganglios linfáticos en el estudio histológico, sin complicaciones mayores (Clavien-Dindo > IIIa), estancia hospitalaria < 21 días, no presentar mortalidad en los 30 días posoperatorios ni readmisión durante esos 30 días. Se realizó un análisis comparativo entre el grupo de TO vs. grupo no TO. Resultados: Se intervinieron 93 pacientes. Alcanzamos el TO en un 34,1% de los pacientes. La variable > 15 ganglios linfáticos fue la que más afectó a conseguir un TO Al realizar el análisis de supervivencia, observamos que el grupo en que se obtuvo el TO presentó mayor supervivencia (p < 0,008). Conclusión: En nuestra serie, la obtención del TO tiene impacto sobre la supervivencia con un grado de cumplimiento del 34,1%. (AU)

Introduction: The textbook outcome (TO) is a multidimensional measure to assess the quality of healthcare practice. This is reflected as the “ideal” surgical result, attending to a series of indicators or established reference points that are adapted depending on the surgical disease that we want to analyze. There are few references and series published about TO, all of them very recent. Objective: We present a series of gastric surgery from the TO perspective and we analyze its impact on survival. Method: Retrospective observational study of all gastric neoplasms operated on in our center. Period: January 2015 - December 2020. The criteria for TO were: margins R0, > 15 lymph nodes in the histological study, no Clavien-Dindo complications > IIIa, hospital stay < 21 days, no mortality or readmission in the 30 postoperative days. A comparative analysis was performed between the TO group versus the non-TO group. Results: 91 patients were operated on. We reached the TO in 34.1% of the patients. The variable > 15 lymph nodes was the one that most affected to achieve a TO. When performing the survival analysis, we obtained that the group in which the TO was obtained had a greater survival (p < 0.008). Conclusion: In our series, obtaining the TO has an impact on survival which 34,1% of degree of compliance. (AU)

Textbook outcome en cirugía gástrica oncológica, ¿qué implicaciones tiene sobre la supervivencia? / Textbook outcome in gastric surgery, what implications does it have on survival?

Introducción: El textbook outcome (TO), o resultado de libro, es una medida multidimensional para evaluar la calidad de la práctica asistencial. Ésta viene reflejada como el resultado quirúrgico «ideal», atendiendo a una serie de indicadores o puntos de referencia establecidos que se adaptan en función de la patología quirúrgica que queramos analizar. Son pocas las referencias bibliográficas y las series publicadas al respecto, todas ellas muy recientes. Objetivo: Valorar el grado de cumplimiento del TO y su impacto sobre la supervivencia. Método: Estudio observacional retrospectivo de todas las neoplasias gástricas intervenidas en nuestro centro. Periodo: desde enero del 2015 hasta diciembre del 2020. Se determinaron los siguientes criterios TO: márgenes R0, > 15 ganglios linfáticos en el estudio histológico, sin complicaciones mayores (Clavien-Dindo > IIIa), estancia hospitalaria < 21 días, no presentar mortalidad en los 30 días posoperatorios ni readmisión durante esos 30 días. Se realizó un análisis comparativo entre el grupo de TO vs. grupo no TO. Resultados: Se intervinieron 93 pacientes. Alcanzamos el TO en un 34,1% de los pacientes. La variable > 15 ganglios linfáticos fue la que más afectó a conseguir un TO Al realizar el análisis de supervivencia, observamos que el grupo en que se obtuvo el TO presentó mayor supervivencia (p < 0,008). Conclusión: En nuestra serie, la obtención del TO tiene impacto sobre la supervivencia con un grado de cumplimiento del 34,1%. (AU)

Introduction: The textbook outcome (TO) is a multidimensional measure to assess the quality of healthcare practice. This is reflected as the “ideal” surgical result, attending to a series of indicators or established reference points that are adapted depending on the surgical disease that we want to analyze. There are few references and series published about TO, all of them very recent. Objective: We present a series of gastric surgery from the TO perspective and we analyze its impact on survival. Method: Retrospective observational study of all gastric neoplasms operated on in our center. Period: January 2015 - December 2020. The criteria for TO were: margins R0, > 15 lymph nodes in the histological study, no Clavien-Dindo complications > IIIa, hospital stay < 21 days, no mortality or readmission in the 30 postoperative days. A comparative analysis was performed between the TO group versus the non-TO group. Results: 91 patients were operated on. We reached the TO in 34.1% of the patients. The variable > 15 lymph nodes was the one that most affected to achieve a TO. When performing the survival analysis, we obtained that the group in which the TO was obtained had a greater survival (p < 0.008). Conclusion: In our series, obtaining the TO has an impact on survival which 34,1% of degree of compliance. (AU)

Textbook outcome in gastric surgery, what implications does it have on survival?

INTRODUCTION: The textbook outcome (TO) is a multidimensional measure to assess the quality of healthcare practice. This is reflected as the "ideal" surgical result, attending to a series of indicators or established reference points that are adapted depending on the surgical disease that we want to analyze. There are few references and series published about TO, all of them very recent. OBJECTIVE: We present a series of gastric surgery from the TO perspective and we analyze its impact on survival. METHOD: Retrospective observational study of all gastric neoplasms operated on in our center. PERIOD: January 2015-December 2020. The criteria for TO were: margins R0, >15 lymph nodes in the histological study, no Clavien-Dindo complications > IIIa, hospital stay < 21 days, no mortality or readmission in the 30 postoperative days. A comparative analysis was performed between the TO group versus the non-TO group. RESULTS: 91 patients were operated on. We reached the TO in 34.1% of the patients. The variable >15 lymph nodes was the one that most affected to achieve a TO. When performing the survival analysis, we obtained that the group in which the TO was obtained had a greater survival (p < 0.008). CONCLUSION: In our series, obtaining the TO has an impact on survival which 34,1% of degree of compliance.

Early postoperative complications after gastric bypass revisional surgery in patients with previous sleeve gastrectomy versus primary gastric bypass.

BACKGROUND: Revisional bariatric surgery (RS) is indicated if there is weight regain or insufficient weight loss, no improvement or reappearance of co-morbidities, or previous bariatric surgery complications. It has been associated with higher postoperative morbidity. OBJECTIVE: To evaluate the early postoperative complications (<30 d) of Roux-en-Y gastric bypass RS (RYGB-RS) after primary sleeve gastrectomy (SG-1) compared with primary RYGB (RYGB-1) at a bariatric surgery referral center. SETTING: Department of General and Digestive Surgery of General Universitary Hospital of Alicante, Spain. METHODS: Retrospective cohort study comparing RYGB-RS after SG-1 and RYGB-1 between January 2008 and March 2021. Postoperative complications, hospital stay, mortality, and readmissions were analyzed. RESULTS: Six hundred and twenty-eight RYGB surgeries (48 RYGB-RS, 580 RYGB-1) were studied. The mean age of patients undergoing RYGB-RS was 50 years, compared with 46 years in the RYGB-1 group (P = .017). Mean initial body mass index was 44.2 kg/m2 (RYGB-RS) versus 47.6 kg/m2 (RYGB-1; P = .004). Cardiovascular risk factors were higher in the RYGB-1 group (P < .05). Indications for RS were weight regain or insufficient weight loss (72.9%), weight regain or insufficient weight loss plus gastroesophageal reflux disease (14.6%), and gastroesophageal reflux disease (12.5%). There were no differences in the frequency of complications (RYGB-RS 22.9% vs RYGB-1 20.5%) or in their severity (Clavien-Dindo ≥IIIa; RYGB-RS 10.4% vs RYGB-1 6.4%; P > .05). There were no differences in emergency room visits (RYGB-RS at 12.5% vs RYGB-1 at 14.9%) or in readmissions (RYGB-RS at 12.5% vs RYGB-1 at 9.4%). CONCLUSION: No differences were observed between primary RYGB and revisional RYGB in early morbidity, mortality, emergencies, or readmissions. Revisional bariatric surgery is a safe procedure at referral centers and must be done by expert hands.