Bariatric Surgery Centers Weigh In with Performance Levels Equivalent Hospitals

What’s in a name? After all, a bariatric surgery performed in a “center of excellence” is still a surgical procedure performed nonetheless. In spite of the impressive name, these hospitals have the occurrence of just as many deaths and complications from the surgical weight-loss procedures as other hospitals.

A group of U.S. researchers says that the additional costs and requirements for hospitals to warrant the designation of bariatric surgery centers of excellence might not be worth the effort. According to Dr. Edward Livingston of the University of Texas Southwestern School of Medicine, “Designation as a bariatric surgery center of excellence does not ensure better outcomes.” The new study appears in the Archives of Surgery.

To be designated a “center of excellence” by the American Society for Metabolic and Bariatric Surgery or the American College of Surgeons, a hospital must meet specified requirements such as performing a minimum of 125 operations per year and must employ a bariatric surgery coordinator as well as trained personnel to perform long-term patient follow-up and record patient outcomes into proprietary databases. In addition, the hospital must pay the cost to subscribe to such a database.

Given all the cost and effort, why seek the bariatric surgery center of excellence designation? Because both Medicaid and Medicare require patients to undergo bariatric surgery at designated centers of excellence, and these federal programs as well as large insurance companies help pay for the costs of the procedure, which ranges from $15,000 to $35,000. In addition, bariatric surgery is fast becoming a popular treatment for obesity. The procedure alters the digestive tract, causing a reduction in the amount of food that can be consumed and digested.

Livingston set out on a quest to find out if patients at centers of excellence, in fact, received better care than other hospitals were able to provide. Data on 19,363 patients who underwent the surgery in the year 2005 was analyzed including data on 5,420 patients who had the surgery performed at a center of excellence. Findings revealed that 1.7 percent of bariatric surgery patients treated at a center of excellence died, compared with a death rate of .09 at other hospitals, In addition, 6.3 percent of patients developed complications compared to 6.4 percent at hospitals with no center of excellence designation. Dr. Livingston concluded that “the much larger number of hospitals that perform low volumes of bariatric procedures have outcomes similar to the high-volume centers of excellence.”

In a separate study published in the same journal, Dr. Michel Suter of Hospital du Chablais in Lausanne, Switzerland, and colleagues studied 492 obese patients having a body mass index (BMI) of 40 to 49 and 133 grossly obese patients having a BMI of 50 or higher, who were treated with gastric bypass surgery between the years 1999 and 2006. Body mass index, is a statistical measurement, which compares a person's weight and height. A BMI of 25 to 30 is considered overweight, while a BMI over 30 is considered obese.

The results of the analysis showed that the grossly obese patients lost 37.3 percent of their body weight compared to the obese patients who lost 34.7 percent of their body weight. Yet, less than half of the grossly obese patients attained a BMI that would indicate simply being overweight even six years after surgery although over 90 percent of the obese patients successfully attained a BMI considered overweight.

However, overall the study showed that patients to benefit from the surgical procedure as the improvements observed in quality of life as well as other health measures were found to similar in both groups. The finding coincides with prior studies that have shown that obese people who undergo weight-loss surgery have a decreased likelihood of dying from heart disease, diabetes and cancer than obese people who don’t.