|
 Researchers analyzed 13 studies with a combined 1.5 million
participants that examined the differences in deaths and major
complications at accredited versus non-accredited centers.
The studies suggest that costs are lower, and the quality of
patients’ experiences is better, at hospitals with accreditation for
bariatric surgery.
Accreditation means the hospital has passed a rigorous review
process during which it proved that it can maintain certain physical
resources, staffing resources, and standards of care.
“Deciding which provider to pick for surgery can be daunting. With
so many different rankings out there, it’s hard to figure out what
makes a real difference,” study author Dr. John Morton, chief of
bariatric and minimally invasive surgery at Stanford School of
Medicine in Palo Alto, California, told Reuters Health. “Evidence
shows that accreditation does make a difference.”
Morton and colleagues report in the Journal of the American College
of Surgeons that in 10 of the 13 studies, accreditation made a
significant difference. Six of the eight studies that reported
mortality showed a significant reduction at the accredited centers;
the risk of death was two to three times higher at hospitals that
weren’t accredited.
Eight of 11 studies showed a reduction in major complications, the
researchers found.
“While quality and safety of bariatric surgery has improved across
the board over the last 10 years, accreditation programs provide the
structure, data collection and oversight for quality improvement and
assessment of patient outcomes,” said Dr. Stacy Brethauer, a
laparoscopic and bariatric surgeon at the Cleveland Clinic in Ohio,
who wasn’t involved in the study.
The review comes at a time when weight loss surgery accreditation is
under scrutiny nationally. Surgical weight loss has gained in
popularity, with more than 180,000 procedures done annually in the
U.S., according to the American Society for Metabolic and Bariatric
Surgery (ASMBS).
In response to the growth, ASMBS and the American College of
Surgeons created accreditation programs in 2004 and 2005. In 2013,
the two nationwide programs merged to create the Metabolic Bariatric
Surgery and Quality Improvement Program.
Most insurers still require accreditation for reimbursement, but
“the glaring exception is Medicare,” said Morton, also immediate
past president of ASMBS.
For several years, the Centers for Medicare and Medicaid Services
did require hospitals to be accredited, but it no longer does.
“Maybe that should be reexamined, especially because Medicare
patients are some of our highest-risk patients who could benefit
even more,” Morton said.
[to top of second column] |
Accreditation for bariatric surgery benefits other hospital
departments, too, Morton noted. Required resources - such as
specialized exam tables and chairs - help accommodate obese patients
hospitalized for other reasons, he said.
“Accredited centers also have the multidisciplinary team, with
experts in psychology and nutrition, for example, to better take
care of patients after surgery,” Morton said. “It’s the whole
culture, frankly.”
Most of the studies spanned the years 2002 to 2011, when centers
were increasing the use of less invasive laparoscopy and gastric
banding, which likely improved outcomes. In addition, researchers
lacked data on patients’ risk factors, such as their body mass index
or how sick they were at the time of surgery.
Also, the authors point out, accreditation itself may not directly
improve outcomes, but rather the surgeon quality or institution
volume associated with accreditation.
“Like any systematic review, the findings are only as good as the
studies that are used to comprise it,” Brethauer said by email. “In
this case, there are relatively few large studies done by a small
number of researchers. Fortunately, the quality of the papers and
the number of the patients overall helps to support the findings.”
As the demand for bariatric surgery grows, patients should research
their surgeons and surgery centers before making critical decisions
about an operation, said Dr. Samer Mattar, chief of the bariatric
services program at Oregon Health and Science University in
Portland.
“Accredited institutions provide a higher quality of care,” said
Mattar, who wasn’t involved in the study. “This confirms that it’s
not a coincidence or fluke. It’s a reality.”
SOURCE: http://bit.ly/2akpcRf Journal of the American College of
Surgeons, online July 13, 2016.
[© 2016 Thomson Reuters. All rights
reserved.] Copyright 2016 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
