A. M. Ibrahim1, A. A. Ghaferi1, J. Thumma1, J. Dimick1 1University Of Michigan,Ann Arbor, MI, USA
Introduction: Responding to reports about the safety of bariatric surgery, leading surgical societies established criteria to create centers of excellence. As a result, many providers underwent changes to obtain accreditation and now nearly all bariatric procedures occur at these centers. Because clinical outcomes are not part of the accreditation process, it unclear if these centers provide high quality care uniformly. Moreover, the geographic availability of centers with high quality outcomes is unknown.
Methods: A retrospective review of 137,016 patients undergoing bariatric surgery at centers of excellence between 2009-2011. Data was obtained from the Healthcare Cost and Utilization Project – State Inpatient Database which included unique hospital identification numbers in 12 states allowing comparisons across 188 centers of excellence. For each hospital, we evaluated quality by calculating the risk and reliability adjusted serious complications rates within 30 days of the index operation. Variations across centers of excellence nationally as well as within each individual state and hospital service area was assessed.
Results: Wide variation in quality exists across bariatric surgery centers of excellence . At the national level, the risk and reliability adjusted serious complication rates at each individual center varied 42 fold ranging from 0.34% to 14.6%. The top and bottom deciles varied 12 fold (top decile 0.5%; bottom decile 6.1%; p<0.005.) Similar variation was seen at the state level as well; California (N=46) ranged from 0.3% to 5.6% and New York (N=35) ranged from 0.5% to 8.6%. For the 47 hospital service areas with a low quality provider (highest quartile of complications), 34 (72%) of them also had an average or high quality provider in the same or adjacent hospital service area.
Conclusions: Even among centers of excellence for bariatric surgery, wide variation exists in rates of post-operative serious complications. Given that most low quality providers are geographically located near higher performing providers, opportunities for quality improvement through local regionalization should be considered.