TY - JOUR
T1 - Identifying High-Quality Bariatric Surgery Centers
T2 - Hospital Volume or Risk-Adjusted Outcomes?
AU - Dimick, Justin B.
AU - Osborne, Nicholas H.
AU - Nicholas, Lauren
AU - Birkmeyer, John D.
N1 - Funding Information:
This study was supported by a career development award to Dr Dimick from the Agency for Healthcare Research and Quality (K08 HS017765). This article represents the personal viewpoint of the authors and cannot be construed as a statement of official Center for Medicare and Medicaid Services or US Government policies.
PY - 2009/12
Y1 - 2009/12
N2 - Background: Payers and professional organizations are expanding accreditation and "centers of excellence" programs in bariatric surgery. Rather than directly measuring outcomes, most programs rely on procedure volume. We sought to determine whether risk-adjusted outcomes or hospital volume were better at predicting future hospital morbidity with bariatric surgery. Study Design: We identified all patients who underwent gastric bypass in the New York State Inpatient database (n = 32,381 patients, n = 105 hospitals). Morbidity was ascertained using a previously validated combination of diagnostic and procedure codes. We first calculated the risk-adjusted morbidity and volume at each hospital during a 2-year period (2003 to 2004). We then ascertained the proportion of hospital-level variation explained by each measure using hierarchical modeling techniques. Finally, we compared the ability of each measure to predict future performance, as assessed with risk-adjusted morbidity, in the next 2 years (2005 to 2006). Results: Risk-adjusted morbidity explained 83% of future hospital-level variation in morbidity compared with only 21% for hospital volume. When comparing the "best" with the "worst" hospital quartiles, risk-adjusted morbidity predicted a more than fourfold difference in future performance (1.7% versus 7.2%; odds ratio [OR]: 4.5; 95% CI, 3.5 to 5.9). Hospital volume predicted only a twofold difference (2.5% versus 4.5%; OR: 1.9; 95% CI, 1.5 to 2.4) from the best to worst quartile. Conclusions: Risk-adjusted morbidity is much better than hospital volume at predicting future performance with bariatric surgery. Rather than focusing on volume, accreditation and centers of excellence programs should focus more on directly measuring outcomes.
AB - Background: Payers and professional organizations are expanding accreditation and "centers of excellence" programs in bariatric surgery. Rather than directly measuring outcomes, most programs rely on procedure volume. We sought to determine whether risk-adjusted outcomes or hospital volume were better at predicting future hospital morbidity with bariatric surgery. Study Design: We identified all patients who underwent gastric bypass in the New York State Inpatient database (n = 32,381 patients, n = 105 hospitals). Morbidity was ascertained using a previously validated combination of diagnostic and procedure codes. We first calculated the risk-adjusted morbidity and volume at each hospital during a 2-year period (2003 to 2004). We then ascertained the proportion of hospital-level variation explained by each measure using hierarchical modeling techniques. Finally, we compared the ability of each measure to predict future performance, as assessed with risk-adjusted morbidity, in the next 2 years (2005 to 2006). Results: Risk-adjusted morbidity explained 83% of future hospital-level variation in morbidity compared with only 21% for hospital volume. When comparing the "best" with the "worst" hospital quartiles, risk-adjusted morbidity predicted a more than fourfold difference in future performance (1.7% versus 7.2%; odds ratio [OR]: 4.5; 95% CI, 3.5 to 5.9). Hospital volume predicted only a twofold difference (2.5% versus 4.5%; OR: 1.9; 95% CI, 1.5 to 2.4) from the best to worst quartile. Conclusions: Risk-adjusted morbidity is much better than hospital volume at predicting future performance with bariatric surgery. Rather than focusing on volume, accreditation and centers of excellence programs should focus more on directly measuring outcomes.
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U2 - 10.1016/j.jamcollsurg.2009.09.009
DO - 10.1016/j.jamcollsurg.2009.09.009
M3 - Article
C2 - 19959037
AN - SCOPUS:70549097001
SN - 1072-7515
VL - 209
SP - 702
EP - 706
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 6
ER -