No reduction in complications after restricting bariatric surgery to centers of excellence

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1. No significant improvement in complications after restriction of bariatric surgery to designated centers of excellence.

2. There does not appear to be any significant reduction in complications between hospitals with and without the designation as a center of excellence.

In a new study published today in JAMA, there were no significant outcome improvements before and after restricting Medicare coverage to centers of excellence (COEs) while controlling for generalized improvements in outcomes over time. The generalized improvements in outcome over time could be attributed to transition to lower risk procedures such as laparoscopic adjustable banding, more experienced surgeons over time, and the increased attraction of lower risk patients to bariatric surgery. Such temporal improvement and the fact that the components of the criteria used to define COEs themselves have not been proven to correlate with improved hospital performance, may explain the absence of an effect after the restriction of surgeries to these places. Further studies detailing long-term outcomes and addressing the potential barrier to access to care due to the restriction of locations to have this surgery need to be conducted to fully reevaluate this policy.  

Click to read the study, published today in JAMA

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1. No significant improvement in complications after restriction of bariatric surgery to designated centers of excellence

2. There does not appear to be any significant reduction in complications between hospitals with and without the designation as a center of excellence

This [retrospective, longitudinal] study: This study analyzed differences in complications and reoperation before and after restriction of Medicare coverage of bariatric surgery to designated COEs (Centers of Excellence) since 2006. Non-Medicare patients were chosen as the control group to account for other factors that led to improved outcomes over time, namely increased use of laparoscopic gastric banding over other types of procedures. There were no significant improvements in outcomes for  serious complications and reoperation (RR 1.14, 0.92, and 0.90 respectively) after implementation of restriction. Hospitals with and without COE designation did not report significant differences in any or serious complications and reoperation (RR 0.98, 0.92, and 1.00 respectively).

In sum: In a new study published today in JAMA, there were no significant outcome improvements before and after restricting Medicare coverage to centers of excellence (COEs) while controlling for generalized improvements in outcomes over time. The generalized improvements in outcome over time could be attributed to transition to lower risk procedures such as laparoscopic adjustable banding, more experienced surgeons over time, and the increased attraction of lower risk patients to bariatric surgery. Such temporal improvement and the fact that the components of the criteria used to define COEs themselves have not been proven to correlate with improved hospital performance, may explain the absence of an effect after the restriction of surgeries to these places. Further studies detailing long-term outcomes and addressing the potential barrier to access to care due to the restriction of locations to have this surgery need to be conducted to fully reevaluate this policy.  

Click to read the study, published today in JAMA

By Elizabeth Park and Rif Rahman

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