2020 General Surgery Presentations

Marcos C Aranda, MD, Jeffrey A Ling, MD, William Chang, MD, Joel R Brockmeyer, MD, Byron J Faler, MD; Dwight D Eisenhower Army Medical Center

Objectives: Multiple bariatric database systems including MBSAQIP have been developed over recent years to aid in research and overall performance improvement. Previous databases lacked the ability to perform analyses on all military treatment facilities (MTFs), and as a result, no prior comprehensive assessment of bariatric surgical practice at MTFs has been performed until now.

Methods: Using MHS Mart (M2), the MTF outpatient medical record system was analyzed from part of 2013 through 2018 for bariatric procedures, demographics, comorbidities, and complications. The 38 MTFs were classified by annual case volume as high volume (HV) with more than 50 cases per year, moderate (MV) with 25 to 50 cases per year, or low (LV) with less than 25 cases per year.

Results: A total of 7758 bariatric procedures were performed. Annual total case volumes ranged from 1279 to 1645 and peaked in 2016. The number of MTFs considered HV ranged from 8 to 10 per year. From 2014 to 2018 HV centers performed an annual average of 75% of total bariatric volume. The most common procedures overall were laparoscopic sleeve gastrectomies (66.7%), laparoscopic gastric bypasses (25.4%), and open gastric bypasses (4.1%). Of the bariatric cases at LV centers, 81% were sleeve gastrectomies, and HV centers performed 80% of all the revisional procedures. Of the patients, 87.6% were female, and the mean patient age was 42. Dependents of retirees were the largest population of beneficiaries at 41.7%. 62.5% were white and 26.7% were black. Common comorbidities included hypertension (45%), GERD (37%), and hyperlipidemia (36%).

Conclusions: In this first comprehensive evaluation of bariatric surgery in MTFs, the majority of bariatric procedures were found to be performed at HV centers. HV centers are responsible for most of the revisional surgeries, and LV centers perform mostly sleeve gastrectomies.