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Weight Loss Surgery Care

Volume of Surgeries

What are we Measuring?

The number of weight loss surgery procedures performed annually.

Why is this Important?

Several studies appear to confirm that surgical teams with experience - that is, routinely performing a sufficient number of cases - get better results.

According to the American College of Surgeons, a Level 1a Center such as BIDMC is required to perform at least 125 or more weight loss operations annually, with at least two credentialed and experienced Bariatric surgeons, each performing a minimum of 100 weight loss operations in the previous 24 months.

What does our performance tell us?

The chart below shows the number of weight loss surgery procedures performed at BIDMC during CYs 2006 through 2010 compared to the recommended national guidelines.

Source of comparison data: American College of Surgeons. Bariatric Accreditation Program Manual, version 7.1.08

BIDMC's volume of weight loss surgery procedures significantly exceeds the (ACS Accreditation requirement) of 125 procedures per year. BIDMC's bariatric surgeons individually meet the requirements to perform at least 100 surgeries each in a 24 month period.

What are we doing to improve?

Over the past year, we have examined the program's process for evaluating patients for surgery and identified areas to improve. In particular, we have made it easier to apply to the program, increased the number of appointments we can offer each week, and improved the efficiency of the evaluation process. We have revamped our information sessions to emphasize patient education and involvement in making decisions about their care, and provide additional information and education via our website.

Length of Stay

What are we measuring?

The average number of days a patient undergoing weight loss surgery stays in the hospital.

Why is this important

The number of days that surgery patients must stay in the hospital is a way of looking at both the efficiency of care as well as its effectiveness. A shorter average length of stay may indicate that patients are recovering more quickly and experiencing fewer complications. However it is important to consider how extensive the surgery is that is being performed. For example, average length of stay does not take into account how ill the patients are, or that not everyone is a candidate for laparoscopic surgery which on average has a lower length of stay because it is less invasive.

What does our performance tell us?

The chart below shows the average length of stay for patients undergoing weight loss surgery at BIDMC during CY 2010.

In CY 2010, BIDMC's average Length of Stay (LOS) for patients undergoing Open Roux-en-Y weight loss surgery was 4.7 days; patients undergoing Laparoscopic Roux-en-Y surgery had an average length of stay of 3.4 days. Patients undergoing Laparoscopic Adjustable Gastric Banding had an average Length of Stay in the hospital of 1.5 days. While there are no nationally recognized benchmarks, BIDMC provides this performance data as additional information for our patients.

What are we doing to improve?

Here at BIDMC we have developed clinical pathways for our weight loss surgery patients. A Clinical Pathway is similar to a large checklist posted next to the patient's hospital bed that serves as a roadmap for both the caregivers and the patient throughout their recovery. It lists everything from what tests a patient can expect before surgery, to how soon he or she should be able to sit in a chair, to when an IV will be removed. With a clinical pathway, everyone is on the same page-nurses, doctors and the patient, clinical pathways contribute dramatically to patient education and patient satisfaction, and an appropriate length of stay in the hospital based upon the specific weight loss procedure performed.

Leak Rate

What are we measuring?

The leak rate for patients undergoing Open or Laparoscopic Roux-en-Y gastric bypass surgery.

Why is this important

An internal leak is one of the most serious complications after Roux-en-Y gastric bypass surgery. Leaks can occur at the stomach to intestine connection or the intestine to intestine connection. Signs of a potential leak are closely monitored in all post operative patients before the patient leaves the hospital.

What does our performance tell us?

The chart below shows the leak rate for patients undergoing Open and Laparoscopic Roux-en-Y gastric bypass surgery at BIDMC during CY 2010 compared to a nationally recognized benchmark.

Source of comparison data: Nguyen NT, Silver M, Robinson M, et al. Result of a national audit of bariatric surgery performed at academic centers: a 2004 University HealthSystem Consortium Benchmarking Project. Arch Surg. 2006;141:445-449.

In CY 2010, BIDMC's leak rate for patients undergoing Open Roux-en-Y or Laparoscopic Roux-en-Y gastric bypass surgery was 0%.  A nationally recognized benchmark used for comparison is 1.6%.

What are we doing to sustain our performance?

While in the operating room, the surgeon visually inspects the connections for any leaks. At BIDMC, we use clinical pathways for weight loss surgery which help to proactively identify the potential for post surgical complications, and take specific steps after surgery based upon the type of procedure performed, specific patient risks, and post surgery recovery progress.

30 Day Post Operative Mortality

What are we measuring?

One important outcome for any surgery patient is survival post-surgery. At BIDMC, we monitor the percentage of patients who have undergone weight loss surgery and die within in 30 days after surgery. This includes patients who die for reasons related to their surgery as well as those who die for other reasons. The mortality rate takes into account that some patients are sicker than others.

Why is this important?

Mortality rate provides general information about the quality of care delivery, and can be an important quality indicator. However, some hospitals care for patients with a greater severity of illness and therefore may have a higher mortality rate. At BIDMC, our 30-day all-cause mortality rate for patients undergoing weight loss surgery is 0% for CYs 2006 through 2010.

Last Updated:  August 18, 2011

Contact Information

Silverman Institute for Health Care Quality and Safety
Beth Israel Deaconess Medical Center
330 Brookline Ave
Boston, MA 02215