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Measuring Care to Improve Surgical Outcomes

The Department of Surgery’s public health sciences division strives to collaborate with surgeons on projects that measure clinical care. This reflects the academic surgery field’s efforts to improve outcomes, but few surgical departments have such a close working relationship with public health researchers. In the department, one example is the work of a public health sciences researcher and a bariatric surgeon to improve long-term outcomes through meta-analysis.

With inspiration from the National Surgical Quality Improvement Program (NSQIP) guidelines to measuring and enhancing surgical care,* health services researcher Su-Hsin Chang, PhD, and bariatric surgeon J. Christopher Eagon, MD, are consolidating two large databases of weight loss surgery patients to try to identify why some patients have less significant weight loss than others. They also are creating a mathematical model of weight loss curves to predict likely weight loss 10 or 15 years after surgery. “This can impact whether health benefits persist, like staying free from diabetes,” Eagon says.

Just as patients are different, there also are a variety of weight loss procedures. Mortality rate is low at 0.31 percent,** but complications have been understudied. Chang and Eagon have previously published research on early major complications, as well as effectiveness and risks of the various bariatric procedures.***

The new merged database will include information from Eagon’s patients from both Barnes-Jewish Hospital and Barnes-Jewish West County Hospital over the past 21 years. Chang will use the data to study barriers to patients returning for care. “We would like to see how adherence to follow-up care relates to long-term outcomes,” she says.

A major component of the combined research effort is patient decision support for those considering weight loss surgery. Currently this includes information sessions with surgeons, as well as question and answer panels with people who have undergone bariatric procedures. It is hoped that the dataset analysis will help answer how best to assist patients in assessing options. Essential to this process is knowing where in the physician-patient interactions to insert that information, Chang observes.

Adds Eagon, “The first step to figuring out how to assimilate and give patients the information they need is to understand what are the true outcomes.”

*Callcut, RA, Breslin, TM. Shaping the Future of Surgery: The Role of Private Regulation in Determining Quality Standards, 2007 Mar, 243(3): 304-312.

**Chang S-H, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surgery. Mar 2014; 149(3):275-87.

***Chang S-H, Freeman NLB, Lee J, Stoll CRT, Calhoun AJ, Eagon JC, Colditz GA. Early major complications after bariatric surgeryin the USA, 2003-2014: a systematic review and meta-analysis. Obesity Reviews. 2018 Apr;19(4):529-537.