Mentorship Programs in Bariatric Surgery Reduce Perioperative Complication Rate at Equal Short-Term Outcome—Results from the OPTIMIZE Trial
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The aim of this study was to determine the efficacy of coaching on outcome in low volume centers of excellence and to evaluate the influence of mentorship programs on the center development.
The number of bariatric procedures has increased steadily in the last years. Providing nationwide bariatric care on a high professional level needs structures to train and guide upcoming centers and ensure high quality in patient care.
A prospective multicentered, observational study including laparoscopic sleeve gastrectomies (SG) and Roux-en-Y gastric bypass (RYGB) procedures was performed. Twelve emerging bariatric centers were coached by five experienced bariatric centers. Surgeons of the mentor centers gave guidance on pre- and postsurgical management of their patients including complications and proctored the first interventions. The results were compared regarding operative outcomes, percentage of excess weight loss, complications, and resolution of comorbidities.
A total of 214 of 293 patients (73.0%) completed the study. The most frequently reported complications were wound infection (4.4%), disorder of emptying stomach/new reflux (2.4%), anastomotic leaks, intra-abdominal secondary hemorrhage, and dumping syndrome (2.0% each). The mortality rate was zero. We found no difference in overall complication rates or resolution of obesity-related comorbidities when comparing experienced surgeons with less experienced surgeons.
Our results suggest that under the conditions of the practices of this study, coaching and mentoring were associated with comparable outcomes both in experienced and emerging centers. In addition, mentorship programs ensure equal outcome quality in terms of improvement of obesity-associated comorbidities.
NCT Number: NCT01754194.
KeywordsObesity Bariatric surgery Mentorship Learning curve Outcome
The authors like to thank the participating hospitals for their commitment: Krankenhaus Bad Cannstatt, Stuttgart, Germany; Bundeswehr Krankenhaus Berlin, Berlin, Germany; Franziskus Hospital Bielefeld, Bielefeld, Germany; Klinikum Bremerhaven-Reinkenheide, Bremerhaven, Germany; Amperklinikum Dachau, Dachau, Germany; Kreiskrankenhaus Emmendingen, Emmendingen, Germany; Universitätsklinik Hamburg Eppendorf, Hamburg, Germany; Ev. Krankenhaus Herne, Herne, Germany; Klinikum Itzehoe, Itzehoe, Germany; Marienkrankenhaus Kassel, Kassel, Germany; Krankenhaus Luebbecke, Luebbecke, Germany; Sana Klinikum Lübeck, Lübeck, Germany; Diakoniekrankenhaus Mannheim, Mannheim, Germany; Krankenhaus Hetzelstift Neustadt/Weinstraße, Neustadt, Germany; Thüringen-Kliniken “Georgius Agricola”, Saalfeld, Germany; Schwarzwald Baar Klinikum Villingen, Villingen-Schwenningen, Germany; and Krankenhaus Winsen, Winsen (Luhe), Germany.
Medtronic MITG supported the study.
Compliance with Ethical Standards
The study protocol, all study protocol amendments, written study patient information, informed consent form (ICF) and any other appropriate study-related information were reviewed and approved by an Independent Ethics Committee (IEC) or Institutional Review Board (IRB) at each study site. The study was also conducted with scientific purpose, value, and rigor and followed generally accepted research practices such as the International Conference on Harmonization Good Clinical Practice (ICH GCP) guidelines. Compliance with these requirements also constitutes conformity with the ethical principles of the Declaration of Helsinki
Conflict of interest
The authors have no financial support or commercial associations that may be a conflict of interest in relation to this article.
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