title: Profiling hospitals on bariatric surgery quality: which outcomes are most reliable?
abstract: BACKGROUND
  Under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, hospitals will receive risk-adjusted outcomes feedback for peer comparisons and benchmarking. It remains uncertain whether bariatric outcomes have adequate reliability to identify outlying performance, especially for hospitals with low caseloads that will be included in the program. We explored the ability of risk-adjusted outcomes to identify outlying hospital performance with bariatric surgery for a range of hospital caseloads.
  
  
  METHODS
  We used the 2010 State Inpatient Databases for 12 states (N = 31,240 patients) to assess different outcomes (eg, complications, reoperation, and mortality) after bariatric stapling procedures. We first quantified outcomes reliability on a 0 (no reliability) to 1 (perfect reliability) scale. We then assessed whether risk- and reliability-adjusted outcomes could identify outlying performance among hospitals with different annual caseloads.
  
  
  RESULTS
  Overall and serious complications had the highest overall reliability, but this was heavily dependent on caseload. For example, among hospitals with the lowest caseloads (mean 56 cases/year), reliability for overall complications was 0.49 and 6.0% of hospitals had outlying performance. For hospitals with the highest caseloads (mean 298 cases/year), reliability for overall complications was 0.79 and 30.3% of hospitals had outlying performance. Reoperation had adequate reliability for hospitals with caseloads higher than 120 cases/year. Mortality had unacceptably low reliability regardless of hospital caseloads.
  
  
  CONCLUSIONS
  Overall complications and serious complications have adequate reliability for distinguishing outlying performance with bariatric surgery, even for hospitals with low annual caseloads. Rare outcomes, such as reoperations, have inadequate reliability to inform peer-based comparisons for hospitals with low annual caseloads, and mortality has unacceptably low reliability for bariatric performance profiling.
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, MI. Electronic address: rkrell@med.umich.edu.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Krell
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Finks
authors.affiliation: Department of Surgery, Michigan State University College of Human Medicine, East Lansing, MI.
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: English
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000592:standards*; D019985:Benchmarking; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D058996:Quality Improvement; D012086:Reoperation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020379:Risk Adjustment / Q000706:statistics & numerical data*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology