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Where Is the Excellence in Bariatric Centers of Excellence?

Bariatric centers of excellence now perform most bariatric surgeries. So if all those centers are excellent, how much does it matter where someone has a surgery performed? Quite a bit. A new review by Tapan Mehta and David Allison in JAMA offers an important conclusion. Accreditation might be a good idea, but by itself, it doesn’t guarantee uniformly high quality care.

Mehta and Allison review the findings of an analysis of Andrew Ibrahim and colleagues. But they also identify opportunities to apply statistical process control insights for future improvements in quality assurance.

Transparency Needed

Ibrahim found quite a bit of variation among bariatric centers of excellence.  Rates of serious complications were more than ten times higher at some centers compared to others. On top of that, a low-performing center might be located near a center that delivers much better outcomes.

Clearly, transparency about the quality of outcomes for different centers could benefit everyone. Right now, all of these centers meet a minimum standard and earn a designation of excellence. But all that excellence is not terribly informative. Patients might want to know the difference between high performers and low performers. Likewise, such transparency could help with setting quality improvement targets.

Distinguishing true excellence has real benefits.

Collaboration to Raise the Bar

Many people have worked hard on establishing the process for accrediting bariatric centers of excellence. So they get a bit touchy when they sense criticism. But everyone seems to agree on one point. More collaboration between high and low performing centers holds great potential to raise the bar for quality in all centers. In fact, the MBSAQIP is working on collaboratives in California, Tennessee, and Virginia.

The fact is that bariatric surgery has become a very safe procedure. But all surgery has risks. So we can never afford to be complacent about continuously raising the bar for quality.

Click here for the new review by Mehta and Allison. For Ibrahim’s study, click here. You can also find an editorial here, and further comments here and here.

Standout, photograph © Abhinay Omkar / flickr

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May 14, 2018

4 Responses to “Where Is the Excellence in Bariatric Centers of Excellence?”

  1. May 14, 2018 at 8:22 am, Michael said:

    It is lamentable that about 99% of people who are indicated for bariatric surgery do not consider these supposed centres of excellence to be an appropriate source of evidence based care for their disease.

    What is wrong with what they’re offering? Would they be able to help more people get better outcomes if they were less focussed on surgery and more focused on the delivery of holistic care for their patients?

  2. May 16, 2018 at 3:04 pm, John Morton said:

    Outcomes for bariatric surgery are excellent with 30 day mortality rates of less than 0.2%, equivalent to removal of a gallbladder. Careful review of the paper reveals that variation in bariatric surgery are degrees of high performance/ the lowest performer exceeds national comparison to other gi procedures. Bariatric surgery is safe and effective and our focus should and will be raising the standard. Read the systematic review by Azagury. All patients are educated about a healthy lifestyle as a prerequisite to surgery. Bariatric surgery reduces mortality by 40 % at 5 years postop. We need to provide a continuum of care for patients in need that can include surgery as appropriate.

  3. May 17, 2018 at 5:15 am, Ted said:

    Thank you, John, for providing an expert perspective. Clearly the misperception of risks associated with bariatric surgery is a huge problem. So your perspective on the safety of the procedure and your excellent work for continuous quality improvement are both important.

  4. May 17, 2018 at 1:21 pm, sheryl said:

    Excellence in Bariatric care cannot be excellent unless the the entire spectrum of care is provided. In most Bariatric Centers of Excellence the focus is mostly on surgery. Enough nutrition education is provided to meet the requirements of the insurance company. After the excellent surgical care there is minimal follow up in terms of nutrition education. Excellent care should mean caring for the entire patient.

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