Death rate, outcomes similar at bariatric surgery centers of excellence, hospitals

Bariatric surgery centers of excellence did not ensure better outcomes than nondesignated hospitals, and additional expenses may not be warranted, according to a study published in Archives of Surgery.

Patients who underwent bariatric surgery at hospitals designated as centers of excellence did not have lower mortality rates or complications than patients whose procedures were performed at nondesignated hospitals.

Researchers examined data from 19,363 bariatric surgeries; 28% were performed at centers of excellence. Data indicate that 0.1% of patients died in the hospital and 6.4% developed complications.

At centers of excellence, the mortality rate was 0.17% compared with 0.09% at nondesignated hospitals.

The complication rate was also similar between facilities — 6.3% at centers of excellence vs. 6.4% at nondesignated hospitals.

Average length of hospital stay was 2.6 days at both centers for excellence and other facilities, but the average cost per patient was higher at centers of excellence ($11,527 vs. $10,984).

“It has been shown that the minimal annual procedure volume required to be designated as a center of excellence does not necessarily result in better outcomes and that the minimum volume requirement is not evidence based,” Edward H. Livingston, MD, chair of surgery at University of Texas Southwestern School of Medicine, wrote.

Bariatric surgery centers are awarded center of excellence designation by the American College of Surgeons or American Society for Metabolic and Bariatric Surgery. Center of excellent guidelines require that centers perform at least 125 operations per year, employ a bariatric surgery coordinator and personnel for long-term patient follow-up and enter outcomes into proprietary databases.

Livingston EH. Arch Surg. 2009;144:319-325.

Use of surgery for treatment of obesity has increased dramatically in recent years. One tenet of current surgical intervention is that patients do better in the hands of experienced surgeons, and centers of excellence in bariatric surgery may facilitate this improvement in quality. In an examination of this hypothesis, Livingston found that designation as a bariatric surgery center of excellence does not ensure better outcomes and neither does high annual procedure volume. He concluded that the extra expenses associated with center of excellence designation may not be warranted.

– George A. Bray, MD

Endocrine Today Editorial Board member