[Define benchmarks for low-risk sleeve gastrectomy: based on the greater China metabolic and bariatric surgery database].

Abstract

Objective: To establish benchmark values for the "optimal" achievable safety outcomes in low-risk patients undergoing sleeve gastrectomy (SG) in China using a standardized benchmarking methodology. Methods: This retrospective case series study was based on the greater China bariatric and metabolic surgery database. According to predefined inclusion and exclusion criteria,1 029 low-risk patients who underwent SG between January 2018 and December 2023 across 12 participating centers were included. The cohort comprised 773 females(75.12%) and 256 males (24.88%),with an age of (31.6±7.8) years (range:18 to 63 years),preoperative body mass index of (37.2±4.8)kg/m² (range:25.0 to 50.0 kg/m²). Twenty-two perioperative safety indicators (within 90 days post-surgery) were collected and analyzed. The benchmark value for each indicator was defined as the 75th percentile of the median values from all participating centers. Results: The cumulative complication rates (Clavien-Dindo classification system≥grade Ⅰ) for low-risk patients were 1.26% within 7 days, 4.86% within 30 days, and 6.90% within 90 days postoperatively. The most common complications within 90 days included dysphagia (2.24%),wound infection (1.65%),and acid reflux (1.17%). The cumulative complication rate demonstrated a gradual increase over time,reaching 12.73% within 4 years after surgery. A significant negative correlation was observed between the cumulative total surgical volume of the centers and the 90-day cumulative complication rate (R=-0.61, P<0.05). The benchmark values were as follows: operative time was 106 minutes,intraoperative conversion-to-laparotomy rate was 0.12%, and cumulative complication rates during hospitalization,within 30 days,and within 90 days were 1.11%,12.37%,and 13.14%, respectively. Specifically,benchmark rates for wound infection were 0.08% during hospitalization, 2.11% within 30 days, and 2.11% within 90 days. Benchmark rates for dysphagia/gastric stenosis were 0 during hospitalization, 1.08% within 30 days,and 1.99% within 90 days. Conclusion: This is the first study to define benchmark values for achievable safety outcomes in low-risk patients undergoing SG in China,providing a critical reference for quality control and benchmarking in Chinese bariatric and metabolic surgery.