Bariatric surgery complications after implementation of a national policy

A study in this week's issue of the Journal of the American Medical Association investigates bariatric surgery complications before vs after implementation of a National Policy Restricting Coverage to centers of excellence.

Starting in 2006, the Centers for Medicare & Medicaid Services has restricted coverage of bariatric surgery to hospitals designated as centers of excellence by 2 major professional organizations.

Dr Justin Dimick and colleagues evaluated whether the implementation of the centers of excellence component of the national coverage decision was associated with improved bariatric surgery outcomes in Medicare patients.

The team performed a retrospective, longitudinal study using 2004-2009 hospital discharge data from 12 states of changes in outcomes in Medicare patients undergoing bariatric surgery.

Bariatric surgery outcomes improved during the study period

Journal of the American Medical Association

A difference-in-differences analytic approach was used to evaluate whether the national coverage decision was associated with improved outcomes in Medicare patients above and beyond existing time trends in non-Medicare patients.

The research team's main outcome measures included risk-adjusted rates of any complication, serious complications, and reoperation.

Bariatric surgery outcomes improved during the study period in both Medicare and non-Medicare patients.

The team reported that this change was already under way prior to the Centers for Medicare & Medicaid Services coverage decision.

After accounting for patient factors, changes in procedure type, and preexisting time trends toward improved outcomes, there were no statistically significant improvements in outcomes after implementation of the CMS national coverage decision for any complication, serious complications, and reoperation.

In a direct assessment comparing outcomes at hospitals designated as centers of excellence vs hospitals without the centers of excellence designation, the team found no significant differences for any complication, serious complications, and reoperation.

Dr Dimick's team concludes, "Among Medicare patients undergoing bariatric surgery, there was no significant difference in the rates of complications and reoperation before vs after the CMS policy of restricting coverage to centers of excellence."

"Combined with prior studies showing no association of centers of excellence designation and outcomes, these results suggest that Medicare should reconsider this policy."