In Reply We appreciate the letter from Petrick et al regarding our study1 on the variation in rates of complication observed at accredited bariatric centers. They raise several important points that we wish to clarify.
First, as noted in our Methods and Limitation sections, Petrick et al correctly point out that we were only able to evaluate a subset of accredited centers within our data set.1 If anything, a more inclusive assessment—including more accredited centers—would likely demonstrate more variation, not less. Because all 12 states in our study consistently demonstrated variation within themselves, we believe our findings to be robust and would replicate if more states were assessed.