A composite measure was devised that included patient and surgeon volume as well as procedure complications to provide an objective place to rate sites that provide various types of bariatric surgeries.

According to the Center for Healthcare Outcomes and Policy at the University of Ann Arbor,* while this doesn’t help to measure site quality, it did contribute to differentiating the risk of complications between both low-scoring and high-scoring surgery locations. The major problem with this model was that it was unable to significantly distinguish between both the medium and high-scoring hospitals.

About the Study

The announcement of this model comes shortly after the Centers for Medicare and Medicaid Services announced they would eliminate the certification requirements needed for facilities that offer bariatric surgical procedures. They reported that they believed that certification has nothing to do with improved outcomes at surgery locations.

Earlier in October 2013, a rating strategy that was based on peer review of quality of operations was published in the New England Journal of Medicine. It was later proven that this approach showed that positive ratings were associated with better surgery outcomes.


This new measure was developed from the data of nearly 2,942 patients who underwent weight loss surgery in Michigan from 2008 to 2010 from the Michigan Bariatric Surgical Collaborative clinical registry. The scale included one, two and three stars. This registry included nearly 75 surgeons and 29 different hospitals.


The type of information gathered included the surgery type, information on the patient’s medical history, the care process as well as the post-op outcome. Some of the procedures studied include gastric banding, both open and laparoscopic gastric bypass, gastric sleeve and duodenal switch.

Other information on these scores included hospital volume as well as risk-adjusted and reliability-adjusted complications rates. The authors of this limited composite complications to those that are life-threatening including bowel obstruction, leakages, bleeding, infection, abscess, venous thromboembolism, respiratory failure, cardiac arrest, renal failure, band-related problems or death. Each hospital or facility was scored on each of these things for each patient.


Adjustments were made regarding a patient’s body mass index, smoking status and comorbid conditions including cardiovascular disease, sleep apnea, diabetes, chronic renal failure, acid reflux, peptic ulcers, musculoskeletal disorders, just to name a few. The reliability and risk complications measured were based specifically on the re-operation, readmission, and length of the patient’s stay.

The authors of this study believe that their action helps hospitals and surgeons to get a better sense of where they truly stand compared to that of their peers. This will allow them to change methods accordingly to lead to greater success for every bariatric surgical patient. While this is just a starting point, the policy implications of the measure’s finding will lead to a new measure of quality in hospitals and facilities that conduct bariatric surgeries.

Center for Healthcare Outcomes & Policy