Outcomes of Bariatric Surgery Performed at Accredited vs Nonaccredited Centers

Abstract

In an effort to improve the quality of care in bariatric surgery, 2 accreditation programs based on volume have been initiated. The aim of this study was to analyze the perioperative outcomes of bariatric surgery performed at accredited vs nonaccredited centers. Patient-level data obtained from the University HealthSystem Consortium for patients who underwent bariatric surgery for the treatment of morbid obesity between 2007 and 2009 were reviewed. Perioperative outcomes were analyzed according to accreditation status. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay, 30-day readmission, overall complications, and cost. Comparisons of length of stay and cost were performed at the hospital-level data. Of the 35,284 bariatric operations performed during the study period, 89.2% of cases were performed at 71 accredited centers; 10.8% of cases were performed at 43 nonaccredited centers. The rate of in-hospital mortality was significantly lower in accredited centers (0.06% vs 0.21%). Compared with nonaccredited centers, bariatric surgery performed at accredited centers was also associated with shorter length of stay (mean difference 0.3 days; 95% CI 0.16 to 0.44) and lower cost (mean difference, $3,758; 95% CI, $2,965 to $3,952). Post-hoc analyses based on procedural type and severity of illness suggested possible associations between center accreditation and improved in-hospital mortality in patients who underwent gastric bypass and patients with higher severity of illness; similarly, patients requiring prolonged ICU or hospital stay (≥7 days) had significantly lower in-hospital mortality within accredited centers. Within the context of academic centers, accreditation status was associated with lower in-hospital mortality. The lower mortality rate associated with accredited centers may be attributed to their ability to recognize and rescue complications.