The American College of Surgeon and the American Society for Metabolic Surgery have implemented programs for accrediting hospitals as Center of Excellence (COE) in response to concern about the safety of Bariatric Surgey and variability among institutions.

According to a study by Nancy J.O Birkmeyer, PhD, from the Department of Surgery at the University of Michigan in Ann Arbor, and colleagues, in July 28 issue of the Journal of the American Medical Association that conducted in Michigan reported that although a lower risk is reported in hospitals performing a higher volume of procedures and with increasing surgeon experience, rate of serious complications during bariatric surgery appears to be about 2.5% and is unrelated to COE designation.

The author noted, “in addition to comparing complication rates by procedure and among hospitals, we examined relationship between procedure volume, COE accreditation, and hospital safety.”

25 hospitals involved in the study and 62 surgeons within the state of Michigan. Since 2006 to 2009, the short-term morbidity was evaluated in 15,275 patients undergoing gastric bypass, laproscopic adjustable gastric band placement, and sleeve gastrectomy.

Overall, at the time of surgery, 7.3% of patients experienced complications. Most often wound problems and other minor complications.
Although were rare for deaths, 0.12% occuring in overall surgery for all patients (0.14% by gastric bypass surgeries, 0.04% by laparoscopic adjustable gastric band operations, and none undergoing sleeve gastrectomy).

Due to surgery complication, the investigator found;
- the most serious complication was associated with Gastric bypass with the rate 3.6%,
- 2.2% for sleeve gastrectomy, and
- 0.9% for laparoscopic adjustable gastric band placement.

In addition, the rates of serious complication among hospital varied from 1.6% to 3.5% (about 2-fold) after adjustment for patient characteristics and procedure mix. Thus, hospitals performing fewer than 150 procedures had a 4.1% rate of serious complications compared with 2.3% in hospitals performing at least 300 procedures annually. Meaning, more procedures performed in a hospital, the risk of serious complication is lower.

Likewise, more-experienced surgeons fared better in terms of serious complications; the rate was 3.8% for surgeons conducting fewer than 100 procedures per year vs 1.9% for surgeons conducting at least 250 cases per year. However, there was no difference in serious complications based on COE designation (2.7% vs 2.0% for COE vs non-COE hospitals, respectively).

Despite the limitations of the study such as only 8 of the 25 hospitals were non-COE that make statistical power to detect differences between COE and non-COE hospital was less than optimal, including the results of the study that may lack generalizability outside of Michigan, Dr. Birkmeyer and colleagues conclude, “the frequency of serious complications among patients after bariatric surgery in Michigan is low. Rates of serious complications are inversely associated with hospital and surgeon procedure volume but not COE status.”

According to the researchers, although they point out that the results reported in this study represent the outcomes of bariatric surgery that are possible, but not necessarily those that are typical in community settings.
They said, “these data may serve as useful safety performance benchmarks for hospitals performing bariatric surgery.”

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