02:24am Tuesday 21 November 2017

Excellence programs do not identify safest hospitals for bariatric surgery

Ann Arbor, Mich. – New data emerges this week about the safety of bariatric surgery and the quality of hospitals that perform the increasingly common weight loss procedures on obese patients.

High volume hospitals had fewer complications, but Center of Excellence accreditation by a professional organization did not predict the safest hospitals for bariatric surgery.

The study led by the University of Michigan Health System appears Wednesday in the Journal of the American Medical Association.

The good news is serious complications were relatively low at 7.3 percent, most of them wound and other minor problems, among 15,275 Michigan patients who had bariatric surgery at one of 25 hospitals in the Michigan Bariatric Surgery Collaborative.

“In the absence of reliable data about outcomes, patients should look for a high volume surgeon and hospital when considering where to have bariatric surgery,” says lead author Nancy Birkmeyer, Ph.D., associate professor of surgery at the University of Michigan Health System and senior scientist at UM’s Center for Healthcare Outcomes and Policy. 

“Whether hospitals are designated as a bariatric Center of Excellence is not important.”

The number of weight-loss procedures, usually recommended for those who have 100 pounds or more to lose, has jumped, from 16,000 in the early 1990s to over 180,000 in 2005. They’ve become the second most common abdominal surgery in the United States.

As surgery rates rose and safety questions lingered, the American College of Surgeons and the American Society of Metabolic and Bariatric Surgeons created center of excellence programs to help assess quality among hospitals.

However, rates of serious complications are 2.7 percent at hospitals designated a center of excellence compared to a similarly low 2 percent at non-designated hospitals. There were a number of reasons why this designation did not necessarily identify safer hospitals.

Although center of excellence applications often ask hospitals for rates of specific outcomes, such as post-surgical blood clots, the data is generally not audited.

Aside from minimum caseloads, most requirements for center of excellence bariatric accreditation – for example, having specialized resources required to care for morbidly obese patients such as larger beds and imaging equipment – are easily met and have little bearing on surgical complication rates.

“Centers of Excellence status may not predict better outcomes because accreditation is based on unreliable, self-reported outcomes data and other unimportant variables,” Birkmeyer says.

Given the highly competitive marketplace for bariatric surgery, center of excellence accreditation programs may be attracting hospitals motivated as much by marketing advantage as by the desire to demonstrate and improve their quality, according to the authors.

Serious complications were about twice as high at 4.3 percent for low volume surgeons at low volume hospitals compared to 1.9 percent for high volume surgeons at high volume Michigan hospitals. A hospital was considered high volume if it performed more than 300 bariatric surgeries per year.

The researchers found that overall, 7.3 percent of patients experienced one or more surgical complications, most of which were wound problems and other minor complications. Serious complications were most common after gastric bypass (3.6 percent), followed by sleeve gastrectomy (2.2 percent), and laparoscopic adjustable gastric band (0.9 percent) procedures.

Data for the study came from the Michigan Bariatric Surgery Collaborative which is a regional consortium of hospitals and surgeons performing surgery in Michigan. The MBSC enrolls 6,000 patients a year from 25 participating hospitals in its registry.

Blue Cross Blue Shield of Michigan and Blue Care Network fund the work of the Michigan Bariatric Surgery Collaborative but had no roles in the design and conduct of the analytic work undertaken by the consortium; collection, management, analysis or interpretation of the data, or preparation of the manuscript.

The efforts of the Michigan collaborative go beyond data feedback. It requires active participation by bariatric surgeons in quality improvement initiatives and mandatory attendance at collaborative meetings held three times a year. Also a project data coordinator visits participating hospitals to check the accuracy of submitted data.

“The relatively low complication rates in Michigan suggest that collaborative quality improvement may be more effective than COE programs,” Birkmeyer says.

The collaborative is still in its first few years of existence and in the future the group hopes to report on the effectiveness of different weight loss procedures, late complications, quality of life, and health care resources devoted to weight loss.

“The power of the consortium and its registry is determining what works to improve patient outcomes and putting that knowledge into practice,” says co-author David Share, M.D., executive medical director for health care quality at Blue Cross Blue Shield of Michigan. “This partnership approach to quality improvement has increased patients’ wellbeing and decreased costs.”

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Additional authors: Justin B. Dimick, M.D., John D. Birkmeyer, M.D. and Jonathan F. Finks, M.D., all of the University of Michigan; Abdelkader Hawasli, M.D., St. John Hospital and Medical Center, Detroit; Wayne J. English, M.D., Marquette General Hospital, Marquette, Mich.; and Jeffrey Genaw, M.D., and Arthur M. Carlin, M.D., of Henry Ford Hospital, Detroit.
Reference: Journal of the American Medical Association, Vol. 304, No. 4, 2010.

Funding: Blue Cross Blue Shield of Michigan, Blue Care Network, Agency for Health Care Research and Quality and the National Institute of Diabetes and Digestive and Kidney Diseases.

Resources:
Michigan Bariatric Surgery Collaborative
http://www.med.umich.edu/mscore/mbsc.html

Michigan Surgical Collaborative for Outcomes Research and Evaluation (M-Score) http://www.med.umich.edu/mscore/about.html

Learn more about bariatric surgery
http://win.niddk.nih.gov/publications/gastric.htm

 Written by Shantell M. Kirkendoll

 

Media contact: Shantell Kirkendoll
E-mail: smkirk@umich.edu
Phone: 734-764-2220


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