To the Editor The American College of Surgeons bariatric centers of excellence (COEs) were established with the aim of improving the quality of patient care and safety. The rigorous accreditation standards to become a COE include the evaluation of a center’s case volume, commitment to quality, appropriate use of equipment and instruments, clinical care support, continuum of care, data collection, and continuous quality improvement.
Drs Mehta and Allison,1 in their discussion of the study by Ibrahim et al,2 suggested that the COE program failed in its principal goal to uniformly improve patient outcomes. In the study, despite centers demonstrating the requisite attributes to be accredited as a COE, serious complications varied from 0.6% to 10.3%.2 Neither operative volume nor case mix explained the differences in the measured outcomes.
Gallagher AG, Angelo RL, Kearney P. Factors Associated With Variation in Outcomes in Bariatric Surgery Centers of Excellence. JAMA. 2018;320(13):1386–1387. doi:10.1001/jama.2018.11194
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