title: The effect of national hospital accreditation in bariatric surgery on perioperative outcomes and long-term mortality.
abstract: BACKGROUND
  Controversy exists regarding the relevance of Center of Excellence accreditation to bariatric surgery outcomes. The objective of this study was to evaluate the impact of national hospital accreditation on perioperative and long-term outcomes following bariatric surgery.
  
  
  METHODS
  Retrospective, longitudinal study using 2004-2010 data from the New York Statewide Planning and Research Cooperative longitudinal administrative database (n = 47,342). Multivariable logistic regression analyzed outcomes following laparoscopic bariatric surgery. Accredited hospitals and accreditation year were identified from the Centers for Medicaid and Medicare website. Outcomes were analyzed with and without temporal correlation to accreditation year.>30-day mortality was determined from social security death records.
  
  
  RESULTS
  Risk of perioperative morbidity OR 1.4 (range 1.2-1.6, P<.001), mortality OR 2.6 (range 1.3-5.4, P = .01) and all-cause long-term mortality OR 1.4 (range 1.2-1.7, P = .0002) were significantly increased in unaccredited versus accredited hospitals on univariate analysis. In accredited hospitals, significant changes in payor and patient mix, operation, perioperative, and long-term outcomes were demonstrated following accreditation. A significant decrease in operations performed on black patients, Hispanic patients, and Medicare patients was also identified. Controlling for patient demographics, co-morbidity, insurance, and operative procedure, multivariable logistic regression demonstrated accreditation as independently associated with fewer major complications versus unaccredited hospitals OR 0.72 (range .63-.83, P<.001) and within the same hospital following accreditation OR .86 (range 0.77-0.96, P = .01). Following multiple cox proportional hazard model analysis, long-term mortality differences were not significant.
  
  
  CONCLUSIONS
  In New York State, bariatric hospital accreditation improved patient outcomes as compared to unaccredited hospitals and within the same hospital compared to preaccreditation. Significant changes were identified for some underserved at-risk populations. Measures to ensure equitable health care for at-risk populations following institutional accreditation are imperative.
authors.affiliation: Division of Bariatric and Advanced Gastrointestinal Surgery, Department of Surgery. Stony Brook University Medical Center, Stony Brook, New York. Electronic address: dana.telem@stonybrookmedicine.edu.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
authors.affiliation: Division of Bariatric and Advanced Gastrointestinal Surgery, Department of Surgery. Stony Brook University Medical Center, Stony Brook, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.affiliation: Division of Bariatric and Advanced Gastrointestinal Surgery, Department of Surgery. Stony Brook University Medical Center, Stony Brook, New York.
authors.forename: Maria
authors.initials: M
authors.lastname: Altieri
authors.affiliation: Department of Preventative Medicine, Stony Brook University Medical Center, Stony Brook, New York.
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Applied Mathematics and Statistics, Stony Brook University Medical Center. Stony Brook, New York.
authors.forename: Qiao
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Division of Bariatric and Advanced Gastrointestinal Surgery, Department of Surgery. Stony Brook University Medical Center, Stony Brook, New York.
authors.forename: Aurora D
authors.initials: AD
authors.lastname: Pryor
mesh_terms: D000068:Accreditation; D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals / Q000592:standards*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000401:mortality / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Accreditation; Bariatric surgery; Center of excellence; Mortality; Outcomes