Surgeon factors are strongly correlated with who receives a sleeve gastrectomy versus a Roux-en-Y gastric bypass

Abstract

Background: Sleeve gastrectomy (SG) has replaced Roux-en-Y gastric bypass (RYGB) as the most common bariatric operation. While SG constitutes ∼70% of all bariatric volume, we hypothesize that the distribution of SG versus RYGB varies widely at the level of the surgeon and that surgeon rather than patient factors are the primary driver of the procedure performed.

Objectives: To determine the distribution of bariatric procedures performed at the surgeon level.

Setting: Population-level analysis using the Statewide Planning and Research Cooperative System (SPARCS) for New York State (2004-2014).

Methods: Identified surgeons performing SG and RYGB using billing codes. Logistic regression performed to determine the impact of surgeon, patient, and hospital factors on receiving a RYGB.

Results: Of the 142 surgeons who perform >5 bariatric operations per year, 32 (22.5%) performed a SG in ≥95% of their bariatric cases in the year 2014. In logistic regression, diabetes (odds ratio [OR] 1.45; P < .001) and gastroesophageal reflux disease (OR 1.36; P < .001) were associated with receiving a RYGB. However, the most correlated factor was whether the surgeon had a RYGB case volume >66^th percentile in the preceding year (OR 33.8; P < .001). In pseudo-R² analysis, 83% of the power of the regression could be explained by surgeon factors alone.

Conclusions: While the percentage of SG in this cohort closely matches the national average, there is wide variation at the surgeon level with a significant proportion predominantly performing a single procedure. Surgeon factors are more strongly correlated with procedure selection compared to patient or hospital factors.

Keywords: Bariatric surgery; Population-level analysis; Practice patterns.