A study published in JAMA Surgery examined bariatric surgical outcomes in centers of excellence.
Ann Arbor-based University of Michigan researcher Andrew M. Ibrahim, MD, and colleagues retrospectively reviewed 145,527 patients claims data after undergoing bariatric surgery at centers of excellence between January 2010 and December 2013.
Researchers examined 165 centers of excellence in Arkansas, Arizona, Florida, Iowa, Massachusetts, Maryland, North Carolina, Nebraska, New Jersey, New York, Washington, and Wisconsin.
Here's what they found.
1. At the national level, risk-adjusted and reliability-adjusted serious complication rates varied 17-fold ranging from 0.6 percent to 10.3 percent.
2. At the state level, variation ranged from 2.1 fold to 9.5 fold.
3. Researchers divided hospitals in quintiles of quality on their adjusted complication rates. Approximately 38 of 132 hospitals had a center in a higher quintile of quality located in the same hospital service area.
4. Variation in complication rates existed at all centers.
Complication rates:
- Low volume — 156 patients, complication range 0.6 percent to 6.4 percent
- Medium volume — 239 patients, 0.6 percent to 10.3 percent
- High volume — 448 patients, 0.6 percent to 4.9 percent
Researchers concluded, "Even among accredited bariatric surgery centers, wide variation exists in rates of postoperative serious complications across geographic location and operative volumes." They recommended that a regional collaboration or selective referral program should be implemented because a large number of centers are located near higher-performing centers.