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Invited Critique
April 20, 2009

Bariatric Surgery Outcomes at Designated Centers of Excellence vs Nondesignated Programs—Invited Critique

Arch Surg. 2009;144(4):325. doi:10.1001/archsurg.2009.18

This study by Livingston uses the NIS administrative database to examine mortality outcomes in accredited vs nonaccredited bariatric surgery centers. As with any study, there are methodological limitations. However, we would like to focus this commentary on improving the quality of bariatric surgery and care.

Clearly, outcome is an important issue for improving most types of medical care. Studies using administrative data, such as the current one, frequently use inpatient mortality as the outcome because it is available and well coded in administrative discharge databases. However, if the bariatric surgeon and patient communities had their druthers, a number of equally, if not more, meaningful outcomes would probably be used to measure the quality of bariatric surgery. At the current time, bariatric procedures have become markedly safer, with substantially lower inpatient mortality rates compared with reports from years past. So, to evaluate the quality of a bariatric surgery program, other outcomes such as weight loss, patient satisfaction, quality of life, and functional status should probably be used in addition to hospital mortality.