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Does Hospital Accreditation Matter for Bariatric Surgery?
John M Morton*1, Trit Garg*1, Ninh Nguyen2
1Stanford University, Stanford, CA;2University of California, Irvine, Irvine, CA
OBJECTIVE(S):
To evaluate the impact of hospital accreditation on bariatric surgery outcomes.
METHODS:
Morbidly obese patients undergoing LRYGB, LAGB, or LSG from the 2010 Nationwide Inpatient Sample (NIS) database were analyzed. Hospital names and American Hospital Association (AHA) codes were used to identify accredited bariatric centers. Data analysis included length of stay (LOS), total hospital charges, complications, mortality, and failure to rescue (FTR). Additional patient demographics, including age, race, sex, and insurance were analyzed.
RESULTS:
There were 117,478 bariatric patient discharges corresponding to 235 unique hospitals in the 2010 NIS dataset. A total of 72,615 (61.8%) discharges, corresponding to 145 (61.7%) named or AHA identifiable hospitals were included in the analysis. Compared to accredited centers, unaccredited centers had a significantly higher mean LOS (2.25 days vs. 1.99 days, p<0.0001), as well as total charges ($51,189 vs. $42,212, p<0.0001). Incidence of any complication was higher at unaccredited centers than accredited (12.3% vs. 11.3%, p=0.001), as was mortality (0.13% vs. 0.07%, p=0.019), and FTR (0.97% vs. 0.55%, p=0.046). Multivariable logistic regression analysis controlling for hospital teaching status, high volume hospital status, patient age, sex, race, insurance, and Charlson co-morbidity score identified unaccredited status as a positive predictor of incidence of complication (OR=1.08, p<0.0001), as well as mortality (OR=2.13, p=0.013).
CONCLUSIONS:
Hospital accreditation status is associated with safer outcomes, shorter LOS, and lower total charges after bariatric surgery.
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