Specialized centers don’t improve weight loss

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People who undergo weight loss surgery at a hospital designated as a center of excellence lose the same amount of weight as their peers treated at non-designated hospitals, but pay more, new research suggests.

Medicare and Medicaid patients undergoing weight loss or “bariatric” procedures are required to have their surgery at a center of excellence, the author notes.

To be designated a bariatric surgery center of excellence the institution must keep a proprietary database of patient outcomes, staff extra personnel to run the program, and perform at least 125 operations annually. 

"These criteria make intuitive sense but lack an evidence base for their application,” Dr. Edward H. Livingston writes in the journal Archives of Surgery.

Livingston, from the University of Texas Southwestern School of Medicine in Dallas, used data from the US National Inpatient Survey to compare outcomes of bariatric surgery at hospitals centers of excellence and hospitals that were not.

In 2005, the report indicates, 24 of 253 named hospitals were designated as a bariatric surgery center of excellence; 28 percent of 19,363 bariatric operations were performed at centers of excellence.

The number of bariatric procedures performed at a center of excellence was substantially greater than at non-designated hospitals and the average cost per patient was significantly higher. Otherwise, patient and facility characteristics were similar.

Death rates and complication rates did not differ between the centers of excellence hospitals and the hospitals that were not centers of excellence, Livingston adds.

SOURCE: Archives of Surgery, April 2009.

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