title: Impact of accreditation in bariatric surgery.
abstract: BACKGROUND
  Several studies have shown improved outcomes associated with accredited bariatric centers. The aim of our study was to examine the outcomes of bariatric surgery performed at accredited versus nonaccredited centers using a nationally representative database. Additionally, we aimed to determine if the presence of bariatric surgery accreditation could lead to improved outcomes for morbidly obese patients undergoing other general laparoscopic operations.
  
  
  METHODS
  Using the Nationwide Inpatient Sample database, for data between 2008 and 2010, clinical data of morbidly obese patients who underwent bariatric surgery, laparoscopic antireflux surgery, cholecystectomy, and colectomy were analyzed according to the hospital's bariatric accreditation status.
  
  
  RESULTS
  A total of 277,068 bariatric operations were performed during the 3-year period, with 88.4% of cases performed at accredited centers. In-hospital mortality was significantly lower at accredited compared to nonaccredited centers (.08% versus .19%, respectively). Multivariate analysis showed that nonaccredited centers had higher risk-adjusted mortality for bariatric procedures compared to accredited centers (odds ratio [OR] 3.1, P<.01). Post hoc analysis showed improved mortality for patients who underwent gastric bypass and sleeve gastrectomy at accredited centers compared to nonaccredited centers (.09% versus .27%, respectively, P<.01). Patients with a high severity of illness who underwent bariatric surgery also had lower mortality rates when the surgery was performed at accredited versus nonaccredited centers (.17% versus .45%, respectively, P<.01). Multivariate analysis showed that morbidly obese patients who underwent laparoscopic cholecystectomy (OR 2.4, P<.05) and antireflux surgery (OR 2.03, P<.01) at nonaccredited centers had higher rates of serious complications.
  
  
  CONCLUSIONS
  Accreditation in bariatric surgery was associated with more than a 3-fold reduction in risk-adjusted in-hospital mortality. Resources established for bariatric surgery accreditation may have the secondary benefit of improving outcomes for morbidly obese patients undergoing general laparoscopic operations.
authors.affiliation: Department of Surgery, University of California, Irvine School of Medicine, Irvine, California.
authors.forename: Alana
authors.initials: A
authors.lastname: Gebhart
authors.affiliation: Department of Surgery, University of California, Irvine School of Medicine, Irvine, California.
authors.forename: Monica
authors.initials: M
authors.lastname: Young
authors.affiliation: Department of Statistics, University of California, Irvine School of Medicine, Irvine, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Phelan
authors.affiliation: Department of Surgery, University of California, Irvine School of Medicine, Irvine, California. Electronic address: ninhn@uci.edu.
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
mesh_terms: D000068:Accreditation; D050110:Bariatric Surgery / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006780:Hospitals, Rural / Q000592:standards / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D013531:Surgicenters / Q000592:standards* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
keywords: Bariatric accreditation; CMS national coverage determination; Center of excellence