{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T15:08:18Z","timestamp":1791644898169,"version":"4.3.4"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Metabolic bariatric surgery (MBS) quality registries monitor various outcomes, enabling the assessment of hospital performance in comparison with national benchmarks. However, if there is considerable between-surgeon outcome variation, surgeon-level feedback may be better suited. The aim of this study was to assess the extent to which patient-, surgeon-, and hospital-level factors contribute to the variation in outcomes after MBS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All primary procedures registered in the Dutch MBS quality registry between 1 January 2020 and 31 December 2023 were included. Outcomes included severe postoperative complications, reoperation, prolonged length of stay (LOS), readmission, textbook outcome, and achieving \u226525% total weight loss within 1\u2005year. Multilevel logistic regression models were built for each outcome, including all available patient characteristics, operating surgeon, and hospital, to determine the variance explained by patient-, surgeon-, and hospital-level factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 30 610 patients were included, operated on by 144 surgeons in 19 hospitals. Hospital-level factors contributed most to the explained variance for all outcomes, ranging from 59.6% for reoperation to 90.3% for prolonged LOS. Surgeon-level factors explained less variance, ranging from 3.2% for prolonged LOS to 28.2% for reoperation. Patient characteristics explained the least, ranging from 4.4% for textbook outcome to 13.1% for severe postoperative complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Variation in outcomes is mostly explained by hospital factors, rather than surgeon factors, supporting hospital-based performance feedback. The results suggest that the pre- and postoperative trajectory and perioperative care may affect MBS outcomes more than patient characteristics or surgical team performance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjs\/znaf186","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T18:39:34Z","timestamp":1759516774000},"source":"Crossref","is-referenced-by-count":2,"title":["Variation in outcomes after metabolic bariatric surgery: multilevel analysis to assess the contribution of patient, surgeon, and hospital factors"],"prefix":"10.1093","volume":"112","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7975-3862","authenticated-orcid":false,"given":"Floris F E","family":"Bruinsma","sequence":"first","affiliation":[{"name":"Department of Surgery, Maastricht University Medical Centre, NUTRIM School for Nutrition and Translational Research in Metabolism , Maastricht ,","place":["The Netherlands"]},{"name":"Scientific Bureau, Dutch Institute 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