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Profiling hospitals on bariatric surgery quality: which outcomes are most reliable?

ABSTRACT: 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.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.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.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.

SUBMITTER: Krell RW

PROVIDER: S-EPMC4171346 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Profiling hospitals on bariatric surgery quality: which outcomes are most reliable?

Krell Robert W RW Finks Jonathan F JF English Wayne J WJ Dimick Justin B JB

Journal of the American College of Surgeons 20140619 4

<h4>Background</h4>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 s ...[more]

PMID: 25154670

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Project description:ImportanceBariatric surgical weight loss is associated with reduced cardiovascular mortality; however, the mechanisms underlying this association are incompletely understood.ObjectivesTo identify variables associated with vascular remodeling after bariatric surgery and to examine how sex, race, and metabolic status are associated with microvascular and macrovascular outcomes.Design, setting, and participantsThis population-based longitudinal cohort included 307 individuals who underwent bariatric surgery. Participants were enrolled in the bariatric weight loss program at Boston Medical Center, a large, multi-ethnic urban hospital, with presurgical and postsurgical assessments. Data were collected from December 11, 2001 to August 27, 2019. Data were analyzed in September 2019.ExposureBariatric surgery.Main outcomes and measuresFlow-mediated dilation (FMD) and reactive hyperemia (RH) (as measures of macrovascular and microvascular function, respectively) and clinical variables were measured preoperatively at baseline and at least once postoperatively within 12 months of the bariatric intervention.ResultsA total of 307 participants with obesity (mean [SD] age, 42 [12] years; 246 [80%] women; 199 [65%] White; mean [SD] body mass index, 46 [8]) were enrolled in this study. Bariatric surgery was associated with significant weight loss and improved macrovascular and microvascular function across subgroups of sex, race, and traditional metabolic syndrome (mean [SD] pre- vs postsurgery weight: 126 [25] kg vs 104 [25] kg; P < .001; mean [SD] pre- vs postsurgery FMD: 9.1% [5.3] vs 10.2% [5.1]; P < .001; mean [SD] pre- vs postsurgery RH: 764% [400] vs 923% [412]; P < .001). Factors associated with change in vascular phenotype correlated most strongly with adiposity markers and several metabolic variables depending on vascular territory (eg, association of weight change with change in RH: estimate, -3.2; 95% CI, -4.7 to -1.8; association of hemoglobin A1c with change in FMD: estimate, -0.5; 95% CI, -0.95 to -0.05). While changes in macrovascular function among individuals with metabolically healthy obesity were not observed, the addition of biomarker assessment using high-sensitivity C-reactive protein plasma levels greater than 2 mg/dL identified participants with seemingly metabolically healthy obesity who had low-grade inflammation and achieved microvascular benefit from weight loss surgery.Conclusions and relevanceThe findings of this study suggest that bariatric intervention is associated with weight loss and favorable remodeling of the vasculature among a wide range of individuals with cardiovascular risk. Moreover, differences in arterial responses to weight loss surgery by metabolic status were identified, underscoring heterogeneity in physiological responses to adiposity change and potential activation of distinct pathological pathways in clinical subgroups. As such, individuals with metabolically healthy obesity represent a mixed population that may benefit from more refined phenotypic classification.

Project description:BackgroundThere is a relative lack of data that systematically investigates the breadth and validity of the association between bariatric surgery and health-related outcomes. We aimed to evaluate the quantity, validity, and credibility of evidence regarding the association between bariatric surgery and health-related outcomes using an umbrella review of meta-analyses.MethodsWe systematically searched PubMed, Embase, and the Web of Science databases from inception until December 2, 2021, to identify meta-analyses of observational or interventional studies that investigated the association between bariatric surgery and multiple health outcomes. We extracted the summary effect size and 95% confidence interval (CI) data. The Assessment of Multiple Systematic Reviews (AMSTAR-2) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines were used for methodological and evidence quality assessments, respectively.ResultsTwenty-eight studies with 82 different health-related outcomes were included in this umbrella review. Beneficial effects of bariatric surgery have been observed in cancer incidence, mortality, cardiovascular risk, polycystic ovary syndrome (PCOS), anxiety symptoms, depressive symptoms, gestational diabetes mellitus, gestational hypertension, large for gestational age (LGA), macrosomia, post-term birth, risk of kidney stones, albuminuria, urinary incontinence, fecal incontinence, Barrett's esophagus, and diabetic retinopathy. However, adverse effects of bariatric surgery were observed for maternal anemia, perinatal mortality, congenital anomalies, preterm birth, neonatal intensive care unit (NICU) admission, intrauterine growth restriction, small for gestational age (SGA), fracture risk, upper limb fracture, suicide, self-harm, and alcohol use disorder (AUD).ConclusionsCurrent evidence suggests that bariatric surgery improves the majority of health-related outcomes; however, caution is advised given it may increase the risk of adverse mental effects, perinatal problems, and fractures.

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Profiling hospitals on bariatric surgery quality: which outcomes are most reliable?

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Profiling hospitals on bariatric surgery quality: which outcomes are most reliable?

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