High-volume hospitals had fewer complications from bariatric surgery, but center of excellence accreditation by a professional organization did not predict the safest hospitals for this increasingly common weight loss procedure for obese patients.
According to a study led by the University of Michigan Health System, serious complications were relatively low at 7.3 percent — most of them wound and other minor problems — among 15,275 Michigan patients who had bariatric surgery at one of 25 hospitals in the Michigan Bariatric Surgery Collaborative. The number of weight-loss procedures, usually recommended for those who have 100 pounds or more to lose, has jumped from 16,000 in the early 1990s to over 180,000 in 2005. They’ve become the second most common abdominal surgery in the United States.
As surgery rates rose and safety questions lingered, the American College of Surgeons and the American Society of Metabolic and Bariatric Surgeons created center of excellence programs to help assess quality among hospitals. However, rates of serious complications are 2.7 percent at hospitals designated a center of excellence compared to a similarly low 2 percent at non-designated hospitals. There were a number of reasons why this designation did not necessarily identify safer hospitals. Although center of excellence applications often ask hospitals for rates of specific outcomes, such as post-surgical blood clots, the data is generally not audited.
Aside from minimum caseloads, most requirements for center of excellence bariatric accreditation — for example, having specialized resources required to care for morbidly obese patients such as larger beds and imaging equipment — are easily met and have little bearing on surgical complication rates. Given the highly competitive marketplace for bariatric surgery, center of excellence accreditation programs may be attracting hospitals motivated as much by marketing advantage as by the desire to demonstrate and improve their quality, according to the study authors.
The efforts of the Michigan collaborative go beyond data feedback. It requires active participation by bariatric surgeons in quality improvement initiatives and mandatory attendance at collaborative meetings held three times a year. Also, a project data coordinator visits participating hospitals to check the accuracy of submitted data. The collaborative is still in its first few years of existence and in the future the group hopes to report on the effectiveness of different weight loss procedures, late complications, quality of life and healthcare resources devoted to weight loss.
Source: University of Michigan Health System, July 27, 2010
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