'Excellence' centers no better for bariatric surgery

NEW YORK (Reuters Health) - For weight-loss surgery, "Centers of Excellence" may not be any safer than their undistinguished peers, a study of 25 Michigan hospitals suggests.

Yet the overall rate of serious complications -- less than three percent -- was "relatively low," the new report said.

The findings, which appear in the Journal of the American Medical Association, come in the wake of widespread safety concerns over weight-loss procedures. (See Reuters Health story of July 26, 2010.)

"Our results show that, at least in the state of Michigan, bariatric surgery is now remarkably safe," Nancy J. O. Birkmeyer, of the University of Michigan in Ann Arbor, told Reuters Health in an e-mail.

But she added that Centers of Excellence, designated by two surgery societies and intended to point people toward safer hospitals, were not necessarily those with the best outcomes for weight-loss surgery.

"In the absence of reliable outcomes data, patients considering undergoing bariatric surgery should look for a high volume surgeon at a high volume center," said Birkmeyer, whose study was funded in part by the Blue Cross and Blue Shield of Michigan, a not-for-profit health insurer.

Although centers need to do at least 125 bariatric surgeries per year to be considered for accreditation, that number would still land them in the lower range among the Michigan hospitals.

The researchers tracked more than 15,000 obese people up to one month after they had surgery. The surgeries included gastric bypass, which reduces the stomach to the size of a golf ball, and gastric banding, in which a silicone band is placed around the top portion of the stomach to restrict food intake.

About seven percent experienced complications, but most were minor wound problems.

Serious complications -- such as massive bleeding or kidney failure -- occurred in 2.6 percent of patients. They were most common in bypass surgery, during which 13 patients (0.14 percent) died; two died during gastric banding (0.04%).

Birkmeyer said a number of studies had shown the benefits of surgery outweighed the risks, with an increase in life expectancy of up to three years.

In 2009, more than 220,000 Americans had bariatric surgery, at a price of about $20,000 per patient, according to the American Society for Metabolic and Bariatric Surgery.

The society, along with the American College of Surgeons, confers the designation of Center of Excellence.

But some of these centers may fall short of excellence when it comes to safety, the new results hint. At first glance, the centers even had a higher rate of complications than did other hospitals. That difference all but vanished after accounting for the type of surgery performed and whether patients had other illnesses, however.

There could be several reasons why the label might not point to safer hospitals, the researchers speculate.

"Given the highly competitive marketplace for bariatric surgery," they write, "(Center of Excellence) accreditation programs may be attracting hospitals motivated as much by marketing advantage as by the desire to demonstrate and improve their quality."

Dr. John Baker, immediate past president of the American Society for Metabolic and Bariatric Surgery, had a different explanation.

He said the hospitals in the study might not compare to other hospitals across the country. As part of the Michigan Bariatric Surgery Collaborative, they all track their outcomes, Baker said, meaning it's likely they're doing the best they can to improve their quality of care, Centers of Excellence or not.

"Outside of this collaborative group you may see a greater variation," he told Reuters Health, adding that large studies hadn't been done.

SOURCE: link.reuters.com/vec89m

JAMA/Journal of the American Medical Association, online July 27, 2010.