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Higher risk of mortality at non-accredited bariatric centres
Bariatric surgery is significantly safer when performed at an accredited centre, according to a study from the from the University of California (UC) Irvine School of Medicine. The research was presented at the 30th Annual Meeting for the American Society for Metabolic and Bariatric Surgery (ASMBS) during ObesityWeek 2013, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The event was hosted by the ASMBS and The Obesity Society (TOS).
Using a nationwide database, researchers from the UC analysed data from 277,068 weight loss operations performed between 2008 and 2011 and found patients who had bariatric surgery at an accredited centre had an in-hospital mortality of 0.08 percent, while those who had surgery at a non-accredited centre had a mortality rate of 0.19 percent, a rate nearly three times higher.
"This study further reinforces that accreditation saves lives," said Dr Ninh T Nguyen, study co-author, Vice-Chair of the Department of Surgery at UC Irvine School of Medicine and the next president of the ASMBS. "This is not a small difference in outcomes."
The UC Irvine study found significantly lower mortality rates for high-risk patients at accredited centres. The mortality rate for the sickest patients was 0.17 percent at accredited centres and 0.45 percent at non-accredited centres. Additionally, patients at accredited centres did better after other laparoscopic operations including antireflux and gallbladder surgery, where in both cases complication rates were lower.
Requirements for accreditation include surgeons perform a minimum of 50 bariatric stapling procedures annually, staff members training in metabolic and bariatric surgery and the availability of equipment that can accommodate patients with severe obesity.
This study comes less than two months after the Centers for Medicare & Medicaid Services (CMS) dropped its seven-year-old accreditation requirement for bariatric surgery facilities performing surgery on Medicare beneficiaries, considered among the highest risk patients because of age and disease severity.
There were more gastric bypass procedures performed at accredited centres than at non-accredited centres (72.4% vs. 67.5%, respectively). For patients who underwent stapling operations (sleeve and bypass), the in-hospital mortality was significantly lower at accredited hospitals (0.09% vs... 0.27% at non-accredited centres).
On multivariate analyses, non-accredited centres had significantly higher in-hospital mortality for stapling procedure (odds ratio, 3.7; p<0.01) but a similar rate of serious morbidity (odds ratio, 0.87; p=0.1). There was no significant difference in in-hospital mortality or serious complication for patients who underwent gastric banding at AC vs. NAC.
Using multivariate logistic regression analyses, morbidly obese patients who underwent common laparoscopic general surgical operations at non-accredited centres had higher serious complication for patients who underwent laparoscopic cholecystectomy (odds ratio, 2.4; p=0.05) and diaphragmatic hernia repair (odds ratio, 2.3; p=0.05) compared to accredited centres. There was no significant difference in risk-adjusted serious complication rate for laparoscopic antireflux and colectomy between the centre types.
The researchers noted that the resources established for accreditation may have secondary benefits that lead to improved outcomes for morbidly obese patients undergoing other general laparoscopic operations.
"The bottom line is if you have severe obesity and are considering bariatric surgery or even other laparoscopic procedures, you should seek out an accredited centre," added Nguyen.
To access the posters and abstracts from Obesity Week, please click here