Skip to main content
SpringerLink
Log in

Quality in Bariatric Surgery

  • Chapter
  • First Online:
The ASMBS Textbook of Bariatric Surgery

  • 1737 Accesses

Abstract

The movement to reduce unjustified variation in care delivery has become a critical component of initiatives to improve the outcomes of surgical procedures and value in healthcare. Surgeons have been at the forefront of quality improvement throughout the history of American medicine. This was particularly true in metabolic and bariatric surgery. Surgical approaches to the treatment of obesity grew slowly from the 1960s to the 1990s with limited adoption. With the demonstration that laparoscopic gastric bypass was feasible, safe, and effective in the late 1990s, the field grew at a rapid pace with wide variation in morbidity and mortality. Societies, regional collaboratives, and individual surgeons responded by creating pathways to provide a structure of programmed longitudinal care. A multidisciplinary team-based approach was developed for patient care, data collection, outcomes reporting, and quality improvement. Reporting structures were unreliable prior to these efforts. In 1999, mortality was reported as 4% for Medicare patients in Washington state. By 2017, mortality had been reduced to 0.08%, for all bariatric procedures in the United States with a highly reliable reporting structure available to all surgeons and hospitals. In the history of surgery, there may not have been a more comprehensive, cooperative, or successful quality improvement effort to ensure access and safe care for patients. This chapter examines the history and current state of quality in metabolic and bariatric surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. The Joint Commission: Over a Century of Quality and Safety. [Internet] 2018 (cited 2018 Dec 15).Available from: https://jntcm.ae-admin.com/assets/1/6/TJC_history_timeline_through_2018.pdf.

  2. Mechanick JI, Garber AJ, Handelsman Y, Garvey WT. American association of endocrinologists position statement on obesity and obesity medicine. Endocr Pract. 2012;18(5):642.

    Article  Google Scholar 

  3. Kyle TK, Dhurandhar EJ, Allison DB. Regarding obesity as a disease: evolving policies and their implications. Endocrinol Metab Clin N Am. 2016;45(3):511–20. https://doi.org/10.1016/j.ecl.2016.04.004.

    Article  Google Scholar 

  4. Poirier P, Cornier MA, Mazzone T, et al. Bariatric surgery and cardiovascular risk factors. Circ: J Am Heart Assoc. 2011;123:1–19.

    Article  Google Scholar 

  5. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2011 (cited 2018 Dec 18); 32(S1): Available from: http://care.diabetesjournals.org/content/34/Supplement_1/S11.full.pdf.

  6. International Diabetes Federation. Bariatric surgical and procedural interventions in the treatment of obese patients with type 2 diabetes. 2011 (cited 2018 Dec 18) Available from: http://www.idf.org/webdata/docs/IDF-Position-Statement-Bariatric-Surgery.pdf.

  7. Institute of Medicine. Envisioning a transformed clinical trials enterprise in the United States: establishing an Agenda for 2020-workshop summary. 13 Apr 2012.

    Google Scholar 

  8. Nguyen NT, Masoomi H, Magno CP, Nguyen XA, Laugenour K, Lane J. Trends in the use of bariatric surgery, 2003–2008. J Am Coll Surg. 2011;213:261–6.

    Article  Google Scholar 

  9. Centers for Medicare & Medicaid Services. National Coverage Determination (NCD) for bariatric surgery for treatment of morbid obesity (100.1). 2012. 100–3(4).

    Google Scholar 

  10. Birkmeyer JD, Shahian DM, Dimick JB, Finlayson SRG, Flum DR, Ko CY, Hall BL. Blueprint for a new American College of Surgeons: National Surgical Quality Improvement Program. J Am Coll Surg. 2008;207(5):777–82.

    Article  Google Scholar 

  11. Share DA, Campbell DA, Birkmeyer N, Prager RL, Gurm HS, Moscucci M, Udow-Phillips M, Birkmeyer JD. How a regional collaborative of hospitals and physicians in Michigan cut costs and improved the quality of care. Health Aff. 2011;30(4):636–45.

    Article  Google Scholar 

  12. Kennedy JF.. Remarks in Heber Springs, Arkansas, at the dedication of Greers Ferry Dam. The American Presidency Project, 1963. Retrieved 2007-04-07.

    Google Scholar 

  13. Birkmeyer NJ, Dimick JB, Share D, Hawasli A, English WJ, Genaw J, Finks JF, Carlin AM, Birkmeyer JD, Michigan Bariatric Surgery Collaborative. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304(4):435–42.

    Article  CAS  Google Scholar 

  14. Livingston EH, Burchell I. Reduced access to care resulting from centers of excellence initiatives in bariatric surgery. Arch Surg. 2010;145(10):993–7.

    Article  Google Scholar 

  15. Staiger DO, Dimick JB, Baser O, Fan Z, Birkmeyer JD. Empirically derived composite measures of surgical performance. Med Care. 2009;47(2):226–33.

    Article  Google Scholar 

  16. HealthGrades. 2011. Bariatric surgery trends in American Hospitals. http://www.medicare.gov/hospitalcompare/search.html. Accessed 10 Feb 2014.

  17. Resources for the Optimal Care of the Metabolic and Bariatric Surgical Patient: Standards Manual: 2014, Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Standards and Pathways Manual [Internet]. 2014 May 1, (cited 10 Sept 2018) Available from: http://www.mbsaqip.org/docs/Resources%20for%20Optimal%20Care%20of%20the%20MBS%20Patient.pdf.

  18. Resources for the Optimal Care of the Metabolic and Bariatric Surgical Patient: Standards Manual: 2016, Improving Health and Transforming Lives, Manual [Internet]. 2016, (cited 10 Sept 2018) Available from: https://www.facs.org/~/media/files/quality%20programs/bariatric/mbsaqip%20standardsmanual.ashx.

  19. Grant MC, Galante DJ, Hobson DB, Lavezza A, Friedman M, Wu CL, Wick EC. Optimizing an enhanced recovery pathway program: development of a post implementation audit strategy. Jt Comm J Qual Patient Saf. 2017;43:524–33.

    Article  Google Scholar 

  20. ASMBS Quality and Patient Safety Committee. 2019; (cited 2019 Jan 14) Available from: https://asmbs.org/committees/patient-safety.

  21. Kotter JP. John Kotter on what leaders really do. Boston: Harvard Business School Press; 1999.

    Google Scholar 

  22. Donabedian A. Explorations in quality assessment and monitoring: the definition of quality and approaches to its assessment. Ann Arbor: Health Administration Press; 1980.

    Google Scholar 

  23. Birkmeyer JD, Dimick JB. Chapter 2. Performance measures in surgical practice. In: ACS surgery: principles and practice elements of contemporary practice. Hamilton, Ontario, Canada: Decker Publishing Incorporated; 2010. Decker intellectual properties.

    Google Scholar 

  24. Iezzoni LI. Risk adjustment for measuring healthcare outcomes. 3rd ed. Chicago: Health Admin Press; 2003.

    Google Scholar 

  25. ASMBS, Estimate of Bariatric Surgery Numbers, 2011–2017. 2018. (cited 2019 Jan 14) Available from: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers.

  26. El Chaar M, Stoltzfus J, Gersin K, Thompson K. A novel risk prediction model for 30 day severe adverse events and readmissions following bariatric surgery based on the MBSAQIP database. Surg Obes Relat Dis. 2019. Publication pending Ref: SOARD_2018_194.

    Google Scholar 

  27. Gupta PK, Franck C, Miller WJ, Gupta H, Forse RA. Development and validation of a bariatric surgery morbidity risk calculator using the prospective, multicenter NSQIP dataset. J Am Coll Surg. 2011;212:301–9.

    Article  Google Scholar 

  28. Nguyen NT, Masoomi H, Laugenour K, Sanaiha Y, Reavis KM, Mills DS, Stamos MF. Predictive factors of mortality in bariatric surgery: data from the Nationwide inpatient sample. Surgery. 2011;150(2):347–51.

    Article  Google Scholar 

  29. Finks JF, Kole KL, Yenumula PR, English WJ, Krause KR, Carlin AM, Genaw JA, Banerjee M, Birkmeyer JD, Birkmeyer NJ, for the Michigan Bariatric surgery collaborative from the Center for Healthcare Outcomes and Policy. Predicting risk for serious complications with bariatric surgery. Ann Surg. 2011;254(4):633–40.

    Article  Google Scholar 

  30. DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis. 2007;3(2):134–40.

    Article  Google Scholar 

  31. DeMaria EJ, Murr M, Bryne TK, Blackstone R, Grant JP, Budak A, Wolfe L. Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Ann Surg. 2007;246(4):578–82.. discussion 583–4

    Article  Google Scholar 

  32. Tan A, Ashrafian H, Scott AJ, Mason SE, Harling L, Athanasiou T, Darzi A. Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years. Surg Endosc. 2016;30:4330–52. https://doi.org/10.1007/s00464-016-4752-x.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Schwaitzberg SD. Financial modeling of current surgical robotic system in outpatient laparoscopic cholecystectomy: how should we think about the expense? Surg Endosc. 2016;30:2082–5. https://doi.org/10.1007/s00464-015-4457-6.

    Article  CAS  PubMed  Google Scholar 

  34. Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med. 2001;137:511–20.

    Article  Google Scholar 

  35. Liu JH, Zingmond D, Etzioni DA, et al. Characterizing the performance and outcomes of bariatric surgery. J Gastrointest Surg. 2002;6:855–61.

    Article  Google Scholar 

  36. Smith MK, Patterson E, Wahed AS, Belle SH, Bessler M, Courcoulas AP, Flum D, Halpin V, Mitchell JE, Pomp A, Pories WJ, Wolfe B. Relationship between surgeon volume and adverse outcomes after RYGP in Longitudinal Assessment of Bariatric Surgery (LABS) study. Surg Obes Relat Dis. 2010;6:118–25.

    Article  Google Scholar 

  37. Courcoulas A, Schuchert M, Gatti G, Luketich J. The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in Pennsylvania: a 3-year summary. Surgery. 2003;134:613–23.

    Article  Google Scholar 

  38. Weller WE, Rosati C, Hannan EL. Relationship between surgeon and hospital volume and readmissions after bariatric operation. J Am Coll Surg. 2007;204:383–91.

    Article  Google Scholar 

  39. Birkmeyer NJO, Dimick JB, Share D, Hawasli A, English WJ, Genaw J, Finks JF, Carlin AM, Birkmeyer JD. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304(4):435–42.

    Article  CAS  Google Scholar 

  40. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009;361:1368–75.

    Article  CAS  Google Scholar 

  41. Nguyen NT, Nguyen B, Nguyen VQ, Ziogas A, Hohmann S, Stamos MJ. Outcomes of bariatric surgery performed at accredited vs. nonaccredited centers. J Am Coll Surg. 2012;215:467–74.

    Article  Google Scholar 

  42. Alamab N, Hobbelinka EL, van Tienhovena AJ, van de Venc PM, Jansmad EP, Nanayakkaraab WB. The impact of the use of the Early Warning Score (EWS) on patient outcomes: a systematic review. Resuscitation. 2014;85(5):587–94. https://doi.org/10.1016/j.resuscitation.2014.01.013.

    Article  Google Scholar 

  43. Dimick JB, Staiger DO, Birkmeyer JD. Ranking hospitals on surgical mortality: the importance of reliability adjustment. Health Serv Res. 2010;45(6 Part I):1614–29.

    Article  Google Scholar 

  44. Dimick JB, Birkmeyer NJ, Finks JF, Share DA, English WJ, Carlin AM, Birkmeyer JD. Composite measures for profiling hospitals on bariatric surgery performance. JAMA Surg. 2014;149(1):10–6.

    Article  Google Scholar 

  45. Petrick AT, Still CD, Wood CG, Vitunac MA, Plank M, McGrail L, Strodel WE, Gabrielsen JD, Rogers j, Benotti P. Feasibility and impact of an evidence-based program for gastric bypass surgery. J Am Coll Surg. 2015;220:855–62.

    Article  Google Scholar 

  46. Birkmeyer NJO, Share D, Baser O, Carlin AM, Finks JF, Pesta CM, Genaw JA, Birkmeyer JD, for the Michigan Bariatric Surgery Collaborative. Preoperative placement of inferior vena cava filters and outcomes after gastric bypass surgery. Ann Surg. 2010;252(2):313–8.

    Article  Google Scholar 

  47. Ask MBSAQIP: Deep Dive into Standard 7.2 Quality Improvement Process | Standard 7.2 QI Process PowerPoint. 2016 Nov 10; (cited 2019 Jan 5): Available from: https://www.facs.org/quality-programs/mbsaqip/ask-mbsaqip.

  48. Minnesota Department of Health, Quality Improvement and Performance Management. (cited 2018 Oct 15.): Available from http://www.health.state.mn.us/qi/.

  49. Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504. https://doi.org/10.1001/jamasurg.2017.0504.

    Article  PubMed  Google Scholar 

  50. Raebel MA, Newcomer SR, Reifler LM, Boudreau D, Elliott TE, DeBar L, Ahmed A, Pawloski PA, Fisher D, Donahoo WT, Bayliss EA. Chronic use of opioid medications before and after bariatric surgery. JAMA. 2013;310(13):1369–76.

    Article  CAS  Google Scholar 

  51. Panagiotou OA, Markozannes G, Kowalski R, Gazula A, Di M, Bond DS, Ryder BA, Adam GP, Trikalinos TA. Short- and long-term outcomes after Bariatric Surgery in the Medicare Population, Technology Assessment Program, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. 2018 Sept 5; (cited 2018 Sept 23) Available from https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/bariatric-surgery/bariatric-surgery-medicare-final-report.pdf.

Download references

Author information

Authors and Affiliations

  1. Metabolic and Bariatric Surgery, Banner University Medical Center – Phoenix, Phoenix, AZ, USA

    Robin P. Blackstone

  2. Department of Surgery, Chinle Comprehensive Health Care Facility, Chinle, AZ, USA

    Thomas P. Petrick

  3. Geisinger Medical Center, Danville, PA, USA

    Anthony T. Petrick

Authors
  1. Robin P. Blackstone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas P. Petrick
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony T. Petrick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anthony T. Petrick .

Editor information

Editors and Affiliations

  1. Department of Surgery, Division of Gastrointestinal Surgery, University of California, Irvine Medical Center, Orange, CA, USA

    Ninh T. Nguyen

  2. Department of Surgery, The Ohio State University, Columbus, OH, USA

    Stacy A. Brethauer

  3. Bariatric and Minimally Invasive Surgery Division, Yale School of Medicine, New Haven, CT, USA

    John M. Morton

  4. Bariatric Surgery, Metabolic and Bariatric Care, CHI Memorial Hospital, Chattanooga, TN, USA

    Jaime Ponce

  5. Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA

    Raul J. Rosenthal

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Blackstone, R.P., Petrick, T.P., Petrick, A.T. (2020). Quality in Bariatric Surgery. In: Nguyen, N., Brethauer, S., Morton, J., Ponce, J., Rosenthal, R. (eds) The ASMBS Textbook of Bariatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-27021-6_40

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-27021-6_40

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-27020-9

  • Online ISBN: 978-3-030-27021-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation