Safety of single anastomosis duodeno-ileal bypass with sleeve gastrectomy adoption in a statewide collaborative using performance monitoring.

BACKGROUND: Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is an emerging bariatric procedure with safety data often limited to single centers or single surgeons. OBJECTIVE: To assess complication rates across a broad range of practices. SETTING: Prospective, state-wide bariatric-specific clinical registry. METHODS: We analyzed prospectively collected data from the Michigan Bariatric Surgery Collaborative (41-hospital consortium) for all primary SADI-S procedures between 2016 and 2025. Firth penalized logistic regression was performed to evaluate risk factors for serious complications. Time-series, funnel plot volume-outcome and risk-adjusted cumulative sum (CUSUM) analyses were performed to evaluate surgeon-specific performance and learning curve. RESULTS: Among 330 SADI-S procedures (13 surgeons, 9 sites), serious complication rate, which included major cardiovascular/pulmonary events, anastomotic leak, renal failure, surgical site infection, venous thrombosis and reoperation was 2.7% and there were no deaths. Funnel plot volume-outcome relationship and CUSUM analysis for surgeons performing > 15 cases (6 surgeons), demonstrated no outliers. Serious complication rates trended at or below 2.7% despite an influx of cases in 2022. Learning curve analysis demonstrated that serious complications declined from 5.2% to 0.9% (P = .018) after 20 cases. CONCLUSION: Among experienced mid-career bariatric surgeons, SADI-S achieved acceptable safety with zero mortality and a low serious complication rate (2.7%) despite increased adoption at different hospitals. Surgeon-specific CUSUM monitoring did not demonstrate any outliers and serves as a framework for safe implementation of emerging procedures. Serious complication rates declined significantly after 20 cases among the study cohort.