title: Does hospital accreditation impact bariatric surgery safety?
abstract: OBJECTIVE
  To evaluate the impact of hospital accreditation upon bariatric surgery outcomes.
  
  
  BACKGROUND
  Since 2004, the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery have accredited bariatric hospitals. Few studies have evaluated the impact of hospital accreditation on all bariatric surgery outcomes.
  
  
  METHODS
  Bariatric surgery hospitalizations were identified using International Classification of Diseases, Ninth Revision (ICD9) codes in the 2010 Nationwide Inpatient Sample (NIS). Hospital names and American Hospital Association (AHA) codes were used to identify accredited bariatric centers. Relevant ICD9 codes were used for identifying demographics, length of stay (LOS), total charges, mortality, complications, and failure to rescue (FTR) events.
  
  
  RESULTS
  There were 117,478 weighted bariatric patient discharges corresponding to 235 unique hospitals in the 2010 NIS data set. A total of 72,615 (61.8%) weighted discharges, corresponding to 145 (61.7%) named or AHA-identifiable hospitals were included. Among the 145 hospitals, 66 (45.5%) were unaccredited and 79 (54.5%) accredited. Compared with accredited centers, unaccredited centers had a higher mean LOS (2.25 vs 1.99 days, P < 0.0001), as well as total charges ($51,189 vs $42,212, P < 0.0001). Incidence of any complication was higher at unaccredited centers than at accredited centers (12.3% vs 11.3%, P = 0.001), as was mortality (0.13% vs 0.07%, P = 0.019) and FTR (0.97% vs 0.55%, P = 0.046). Multivariable logistic regression analysis identified unaccredited status as a positive predictor of incidence of complication [odds ratio (OR) = 1.08, P < 0.0001], as well as mortality (OR = 2.13, P = 0.013).
  
  
  CONCLUSIONS
  Hospital accreditation status is associated with safer outcomes, shorter LOS, and lower total charges after bariatric surgery.
authors.affiliation: *Bariatric and Minimally Invasive (BMI) Surgery, Stanford School of Medicine, Stanford, CA †Gastrointestinal Surgery, University of California, Irvine.
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
authors.forename: Trit
authors.initials: T
authors.lastname: Garg
authors.forename: Ninh
authors.initials: N
authors.lastname: Nguyen
mesh_terms: D000068:Accreditation; D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects; D005260:Female; D017722:Hospital Charges; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology*; D055815:Young Adult