University of Oulu

Sheraz R Markar and others, Bariatric surgery volume by hospital and long-term survival: population-based NordOSCo data, British Journal of Surgery, Volume 110, Issue 2, February 2023, Pages 177–182,

Bariatric surgery volume by hospital and long-term survival : population-based NordOSCo data

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Author: Markar, Sheraz R.1,2,3; Santoni, Giola1; Holmberg, Dag1;
Organizations: 1Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
2Department of Surgery and Cancer, Imperial College London, London, UK
3Nuffield Department of Surgery, Oxford University, Oxford, UK
4Surgery Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
5School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2023
Publish Date: 2023-08-08


Background: It is unclear whether annual hospital volume of bariatric surgery influences the long-term survival of individuals who undergo surgery for severe obesity. The hypothesis that higher annual hospital volume of bariatric surgery is associated with better long-term survival was evaluated.

Methods: This retrospective population-based study included patients who underwent bariatric surgery in Sweden and Finland between 1989 and 2020. Annual hospital volume was analysed for risk of all-cause mortality. Multivariable Cox regression provided HRs with 95 per cent confidence intervals adjusted for age, sex, co-morbidity, country, and type of bariatric procedure.

Results: Weight loss surgery was performed in 77 870 patients with a 0.5 per cent risk of postoperative death (mortality rate (MR) per 100 000 people 592.7, 95 per cent c.i. 575.0 to 610.9). Higher annual hospital volume of bariatric surgery was associated with a lower risk of all-cause mortality. The adjusted HRs were slightly more reduced for each quartile of annual hospital volume compared with the lowest quartile (MR per 100 000 people for lowest quartile 815.1, 95 per cent c.i. 781.7 to 849.9; for quartile II: HR 0.88, 95 per cent c.i. 0.81 to 0.96 (MR per 100 000 people 545.0, 512.0 to 580.1); for quartile III: HR 0.87, 0.78 to 0.97 (MR per 100 000 people 428.8, 395.5 to 465.0); for quartile IV: HR 0.82, 0.73 to 0.93 (MR per 100 000 people 356.0, 324.1 to 391.1)). In analyses restricted to laparoscopic surgery, volume and mortality were related only in the crude model (HR 0.86, 0.75 to 0.98), but not in the multivariable model (HR 0.97, 0.84 to 1.13) that compared highest and lowest quartiles.

Conclusions: If there was a survival benefit associated with hospital volume, it may have been due to a faster uptake of laparoscopic surgery in the busier hospitals.

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Series: British journal of surgery
ISSN: 0007-1323
ISSN-E: 1365-2168
ISSN-L: 0007-1323
Volume: 110
Issue: 2
Pages: 177 - 182
DOI: 10.1093/bjs/znac381
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This study was funded by the Swedish Research Council.
Dataset Reference: The NordOSCo data set is available from public repository upon request.
Copyright information: © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited