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.

Conclusion: 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.

Keywords: Accreditation; Bariatric surgery; Center of excellence; Mortality; Outcomes.