In this lecture, Dr. Ponce explains the concept of Center of Excellence and how to get there, based on the US experience.
In the United States of America, the “Center of Excellence” accreditation was established in the 2000s, after bariatric surgery yielded questionable outcomes, preventing patients from accessing coverage from insurance companies for these types of procedures. After a significant increase in laparoscopic surgery and more appropriate data reporting, results on morbidity, readmissions, reoperations and, more importantly, mortality, improved significantly. The initial parameters that insurance companies sought were unfair, but the COE was born.
This accreditation allows for quality improvement and patient safety. It is based on three pillars: Structure: includes infrastructure, equipment, material and human resources, etc.Process: patient selection, protocols and pathways, surgical technique, in-hospital and follow-up careOutcomes: complications, length of stay, 30-day morbidity, mortality, long-term weight-loss and comorbidity resolution.
In 2012, the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery joined efforts to establish a single protocol, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBASQIP). These guidelines allow for the evaluation of each bariatric unit and determine whether or not it meets the standards. Studies show that COEs have better outcomes than non-COE centers, even when comparing high-volume centers. The difference in mortality rates seems to be due to the failure to rescue patients with an acute complication. Early diagnosis and treatment in specialized centers with standardized pathways and access to critical care offer better results.
The MBASQIP was published in the form of a manual describing all the different parameters to be met, including: Institutional commitmentVolume criteria (50 stapling cases/year has been established as the minimum) Obesity CommitteeEquipment and resourcesProtocols and pathwaysData system (reliable data collection, with well-defined data points and a dedicated clinical reviewer) Quality improvement (identification and addressing of specific problems, i.e. DVT with an adequate prophylactic scheme).
In summary, COE status can improve safety and outcomes, allows for data acquisition, and can increase hospital support for bariatric program implementation.
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