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 Researchers examined rates of serious complications within 30 days
of weight loss operations for 145,527 patients at 165 bariatric
centers of excellence in 12 U.S. states.
Wisconsin had the least amount of variation among facilities in
complication rates, which ranged from 1.5 percent to 3.3 percent,
researchers report in JAMA Surgery. Nebraska had the most variety,
with complication rates ranging from 1 percent to 10.3 percent.
Often, surgery centers with higher complication rates were close to
other centers with lower complication rates, the study also found.
“Patients are likely unaware of the variation,” said lead study
author Dr. Andrew Ibrahim of the University of Michigan in Ann
Arbor.
“In fact, many surgeons may be surprised by the findings,” Ibrahim
said by email.
Before there were any centers of excellence, or even basic
accreditation programs for bariatric surgery, death rates were as
high as 9 percent in some centers that didn’t do a huge number of
these operations each year, researchers note.
In a push to improve quality and curb death and complication rates,
the American College of Surgeons and the American Society for
Metabolic and Bariatric Surgery combined their two separate
accreditation programs into a single nationwide program in 2012.
This set out uniform criteria for so-called centers of excellence
for bariatric surgery. Among other things, qualifying hospitals have
to do a certain number of these operations each year and use special
operating tables and equipment for bariatric patients.
For the current study, researchers analyzed complication rates from
2010 to 2013 at bariatric centers of excellence in Arizona, Florida,
Iowa, Massachusetts, Maryland, North Carolina, Nebraska, New Jersey,
New York, Washington and Wisconsin.
They focused on serious complications like bleeding, heart and lung
problems, organ injury, wound infections and repeat operations.
Patients in the study were around 47 years old on average and most
of them were white and female. In addition to obesity, many of them
had other health problems like high blood pressure, diabetes,
depression and lung disease.
More than half of them had what’s known as laparoscopic Roux-en-Y
gastric bypass, which reduces the stomach to a small pouch about the
size of an egg.
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Nearly all of the bariatric centers of excellence in the study were
in urban areas, and about 71 percent were based at teaching
hospitals.
When researchers grouped hospitals with similar complication rates,
they found 28 percent of the centers had at least one nearby
facility with lower complication rates.
Volume, or the number of surgeries done at each center, didn’t
appear to influence complication rates at the low end of the
spectrum. The lowest complications rates seen were about 0.6 percent
at high-, medium- and low-volume facilities.
But the highest complication rates seen, 10.3 percent, were at
medium-volume centers, compared to 6.4 percent at low-volume centers
and under 5 percent at high-volume centers.
One limitation of the study is that researchers lacked data on
individual surgeons, Ibrahim said.
“We think a large part of the variation may be explained by the
skill of the surgeon and care they receive after surgery,” Ibrahim
said.
The findings suggest that while bariatric surgery is much safer now
than it was a decade ago, just accrediting centers of excellence may
not be enough on its own to guarantee high quality care, said Dr.
Rajesh Aggarwal, author of an accompanying editorial and researcher
at McGill University in Canada.
“There is still more improvement work to be done, and we cannot sit
on our laurels,” Aggarwal said by email.
SOURCE: http://bit.ly/2po6koT and http://bit.ly/2oUSs71 JAMA
Surgery, online April 26, 2017.
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