American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Institutional infrastructure important for bariatric surgery outcomes

OCTOBER 24, 2017
Clinical Congress Daily Highlights, Tuesday Second Edition

Bariatric surgery was once dismissed due to poor outcomes. However, techniques have progressed significantly over the past several decades, and today such procedures have low mortality and are helping patients achieve better health. In 2016, approximately 216,000 bariatric surgery procedures were performed.

Stacy A. Brethauer, MD, FACS, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, provided an overview of the history of bariatric surgery on Tuesday, tracing the upward trend in cases and noting a shift to a laparoscopic approach that has been accompanied by increased acceptance.

“It became more accepted by patients and it became more of a subspecialty in and of itself, as we developed fellowship and training programs around the discipline of bariatric surgery, not just as a procedure but as a practice,” he said.

As these surgeries increased in popularity, the American College of Surgeons (ACS) and American Society for Metabolic and Bariatric Surgery (ASMBS) created the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). This initiative standardizes accreditation for bariatric surgery centers and provides a large database of bariatric surgery cases. Its primary purpose is to provide risk-adjusted, comparative data for the purpose of benchmarking and continuous quality improvement. Currently the MBSAQIP has 855 participating centers.

In a controversial move, in 2013 the Centers for Medicare & Medicaid Services (CMS) removed the National Coverage Determination requiring bariatric surgery patients to use centers accredited by either the ACS or ASMBS, in part due to the decreasing risk of such procedures. This decision sparked study into whether outcomes differed between accredited and nonaccredited centers.

Ninh T. Nguyen, MD, FACS, John E. Connolly Professor and Chair, Department of Surgery, University of California Irvine Medical Center, presented data showing that accredited centers showed significantly reduced in-hospital mortality compared with nonaccredited centers. He showed that while procedure-specific metrics may be comparable, other factors related to the overall hospital environment were a major cause of the difference. “Even if you have a very experienced surgeon, you can get low complications. However, your overall complications can be higher because of the infrastructure associated with the institution.”

As Anthony T. Petrick, MD, FACS, Geisinger Health System, Danville, PA, agreed: “As bariatric surgeons, we strongly believe this isn’t just about the operation itself, but equally as important or perhaps even more important is the supporting program that goes around that surgery.”

A common challenge in bariatric surgery is readmission to the hospital. John M. Morton, MD, MPH, FACS, FASMBS, chief, Minimally Invasive and Bariatric Surgery, Stanford School of Medicine, CA, presented data from the Decreasing Readmissions through Opportunities Provided (DROP) study, which uses supportive content and materials to reduce the rate of readmission. Through efforts such as educational videos, postoperative phone calls, and help cards with contact information, the DROP study found a 12 percent reduction in readmissions as well as a decline in length of stay, suggesting that pre- and postoperative support can help minimize these preventable events.

Matthew M. Hutter, MD, MPH, FACS, Massachusetts General Hospital, Boston, MA, discussed the importance of patient-reported outcome measures (PROMs), which ensure inclusion of the patient’s voice in assessing a treatment’s success. He has collected data from patients, caregivers, and family in both the preoperative and postoperative setting to identify important patient-centric metrics. Currently, his team is developing an online patient portal that allows patients to report such measures, which may ultimately provide surgeons with a better overall assessment of treatment efficacy.

Additional Information:
The Panel Session, Quality Lessons Learned from Bariatric Surgery, was held October 24, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at