Sunday, May 3, 2009

Does Bariatric Surgery Volume Make a Difference In the Number of Surgery Related Complications?

A resent study done by Dr. Edward H. Livingston, of the University of Texas Southwestern School of Medicine and Department of Veterans Affairs in Dallas, indicates that the complication rate for patients undergoing bariatric surgery is essentially the same at Center of Excellence (COE) facilities as at non-COE facilities. The study concludes that ‘Designation as a bariatric surgery center of excellence does not ensure better outcomes. Neither does high annual procedure volumes.’

A 2008 Health Grades bariatric study concluded that volume is very important in reducing the complication rate in bariatric surgery. The Health Grades study found that those facilities that had done at least 125 surgeries during a year had fewer complications than those facilities that had done 25 or less surgeries.

A 125-surgery-per-year minimum is an important element in the COE criteria established by both The American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS). Moreover, Medicare will consider paying for bariatric surgery only if the surgery is performed at a COE facility, certified by the ASMBS or the ACS. So, there is support for the 125 per year bariatric surgical minimum as a basis for achieving surgical proficiency.

Based on the Livingston study, facilities performing less than 125 surgeries per year -- actually, an average of 79 surgeries -- have a complication rate similar to facilities performing 125 surgeries or more per year. Although this conclusion may reflect an accurate assessment of the study results, we don’t feel that the results necessarily mean that volume doesn’t count. The results may indicate that performing 79 surgeries per year is a good number from which to gain bariatric surgical proficiency.

However, we don’t believe that the Livingston study results mean that a bariatric center that performs 15 surgeries per year is likely to have a lower complication rate than a center that performs 125 surgeries per year. We do believe that volume counts. Further, we believe that emphasizing a high volume is a good marketing tool for a weight loss center to use as part of an overall marketing strategy.


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