We read with great interest the article by Dr Livingston entitled “Bariatric Surgery Outcomes at Designated Centers of Excellence vs Nondesignated Programs.”1 Dr Livingston concluded from his analysis that the COE system for bariatric surgery does not improve surgical outcomes while increasing programmatic expenses. We believe that Dr Livingston's analysis has several flaws in its methodology and interpretation that enabled him to reach these conclusions.
Scott A. S, Bruce W, Bruce S. Bariatric Centers of Excellence Programs Do Improve Surgical Outcomes. Arch Surg. 2010;145(1):105-106. doi:10.1001/archsurg.2009.255