Gastric Sleeve Patient Outcomes – Update 2016
It’s a new year which means it is time to evaluate my performance for the previous year, and update my outcomes statistics. This is am important and ongoing part of my practice.
My #1 goal since starting my weight loss surgery practice in 2002 has been to achieve not just excellent patient outcomes, but industry-leading patient outcomes. This is not easy to achieve. It requires me to do better surgery and patient care than the majority of my bariatric surgeon peers.
The way I know if I am meeting this goal is by very closely tracking my patient outcomes. This is another important and ongoing part of my practice. I estimate I have spent over 1000 hours on data entry and data analysis over the past 14 years in my effort to be accountable for my patient outcomes.
A quick aside: keeping track of patient outcomes is unfortunately the exception rather than the rule in medicine. I have always been amazed at how few doctors keep track of their own outcomes statistics. As they say, ignorance is bliss.
In this post I will discuss my 2016 gastric sleeve patient outcomes, and my updated overall gastric sleeve patient outcomes statistics.
To read about my non-outcomes 2016 patient details (e.g. age, bmi, insurance, etc), and the 2016 weight loss surgery trends I have observed (e.g. changes in insurance coverage, favored operations, etc), click here.
Gastric Sleeve Patient Outcomes 2016 – Weight Loss
Through the end of December 2016 I’ve completed 375 gastric sleeve operations. Updated weight loss outcomes including the data from 2016 are shown in the table below:
|Percent of Excess Weight Loss (% EWL)|
|6 months||59% EWL|
|1 year||76% EWL|
|2 years||80% EWL|
|3 years||75% EWL|
These gastric sleeve weight loss statistics are significantly better than the published industry averages.*
The industry average gastric sleeve weight loss, according to a study by Gagner et al, who analyzed data from a large number of surgeons/operations (130 surgeons, 46,133 gastric sleeve operations), is 55-59% EWL at 1-3 years after surgery (59.3% EWL at 1 year, 59.0% EWL at 2 years, 54.7% at 3 years).*
Why are my gastric sleeve weight loss results better than the industry average? The answer, in my opinion, is better surgery and better patient care than the industry average.
The smaller the sleeve, in my experience, the better the weight loss. The issue, however, is that it is harder and takes longer to make a smaller sleeve. There is less margin for error when the sleeve is made small. Much attention and effort must be directed at getting the details of the operation exactly right to avoid potential complications like leak. This requires skill, experience, time, and effort. It is much quicker and easier to make a larger sleeve.*
Better Patient Care
The same goes for patient care. Delivering excellent, high quality, effective patient care (education, support, follow-up) takes much more time and effort than delivering mediocre patient care.*
In my opinion, the simple reason for why my gastric sleeve weight loss outcomes are better than the industry average is because I devote the time and effort necessary to do better surgery and better patient care, as described above.*
To read more about gastric sleeve weight loss, click here.
Gastric Sleeve Patient Outcomes 2016 – Leak
This section is easy. My gastric sleeve leak rate was 0% entering 2016, and it remains 0% exiting 2016.**
To review, a leak is a hole in the stomach that can develop during healing after gastric sleeve surgery. It is a serious complication that can be life-threatening. Surgeons in general are very focused on trying to prevent leaks.
The industry average leak rate, according to a study by Aurora et al, who compiled data from 29 different published leak studies involving 4,888 gastric sleeve operations, is 2.4%, with a range between surgeons from 0% to 7%.**
Leaks generally occur because of technical issues related to the performance of the operation. The easiest way for a surgeon to avoid the technical issues that can cause a leak is to make the sleeve larger. This is a strong incentive to make a larger sleeve, and a main reason, in my opinion, for why the industry average gastric sleeve weight loss is 55-59% EWL and not higher.**
If the sleeve is to be made smaller, careful attention must be paid to getting the details of the operation exactly right to avoid leak and other potential issues. This takes more time and effort.**
In my opinion, the reason for why my leak rate (0%) is lower than the industry average leak rate of 2.4% is because I devote the time and effort it takes to get the details of the operation as perfect as possible.**
To read more about gastric sleeve leak, click here.
Gastric Sleeve Patient Outcomes 2016 – Heartburn/Acid Reflux
Heartburn/acid reflux is the main potential long-term issue after gastric sleeve surgery. Published studies suggest that the most important determinant of heartburn risk is who the surgeon was (reference).*
In my experience, to minimize the long-term risk for heartburn/acid reflux, it is very important to evaluate patients for hiatal hernia during surgery, and to repair even small and subtle hiatal hernias when found. Preoperative studies like ugi and egd are not reliable to rule out the existence of hiatal hernia.
The huge variation in reported heartburn/acid reflux rates after gastric sleeve surgery, in my opinion, is due to variable aggressiveness on the part of surgeons to look for and repair hiatal hernias.
Of note, insurance often doesn’t pay for hiatal hernia repair if done at the time of the gastric sleeve operation, so there is a financial incentive to not look very carefully for hiatal hernias.
The incidence of worsened heartburn/acid reflux in my gastric sleeve patients is 11-15%, depending on how I do the calculation.*
Of note, my heartburn rates have decreased as I have become more aggressive at looking for and repairing hiatal hernias. In my first 30 gastric sleeve operations, the incidence of worsened heartburn/acid reflux was 30%, much higher than the rate subsequently.*
To read more about my Orange County weight loss surgery program, visit www.OliakCenter.com.
* Patient results vary after weight loss surgery. The gastric sleeve outcomes quoted on this page are averages – individual patients can do better or worse than the average.
** Leaks can occur after gastric sleeve surgery. Past leak rates may not be indicative of future leak rates.