"To measure outcome well you have to do what’s called risk adjustment," Blackstone says. "That means you actually have to know what are the factors about the population that make them higher risk or lower risk. Traditionally over the years a number of risk adjustments have been done and the procedure itself is a major risk factor."
Other risk factors include male gender, tobacco use, renal failure, and heart disease, she says.
The Raleigh (NC) Center for Weight Loss Surgery, which performs surgeries at Rex Healthcare, focuses on outcomes as a quality measure.
"The top quality metrics we’re most focused on are mortality rates, readmission rates, reoperation rates—those are the biggest ones," says Joseph Moran, MD, founder of the weight-loss center, which is a recognized Center of Excellence by the ASMBS and accredited by the Surgical Review Corporation.
"Once you get past that, then people look at things like excess body weight loss and percent body weight loss and comorbidity resolution. These are the most important metrics that we as an institution and program look at to make sure we’re exceeding the standards published in the U.S."
Provost Bariatrics, too, recognizes the importance of tracking quality outcomes, focusing on readmissions, reoperations, wound infection rates, and venous thromboembolism incidents.
"Some of these metrics are tracked through the hospital and some are through the practice, and we look at them on a regular basis," says David Provost, MD, founder and surgeon at the Denton, TX, practice, also certified as a Center of Excellence by the ASMBS. "Some incidents are infrequent enough to where we haven’t had to act on them. The nice thing is when you track outcomes, you can recognize clusters of adverse events—if you don’t follow it or don’t track it, you’ll never know."