Authors' recommendations: Evidence suggested that high-volume hospitals and surgeons were associated with improved patient outcomes in terms of in-hospital mortality and morbidity, but data were equivocal regarding length of hospital stay. While these findings support the development of bariatric surgery COE, it should be noted that it was not possible to define a minimum annual case volume due to the heterogeneity of methods, lengths of follow-up and risk adjustment strategies used in the studies. It was also difficult to determine whether outcome differences between accredited and non-accredited centres were related to volume or accreditation status, or other factors, such as the specific service, training and equipment requirements associated with accredited centres. Payments for services were similar following implementation of a policy restricting coverage to COE in the United States, although accredited centres may be associated with lower costs. Evidence from the United States also suggested that policy makers should be cognizant of the potential for centralisation programs to adversely affect patient access to services. The effects of such policies may also differ depending on the local context in which the policy is being implemented. The majority of the evidence to date stems from the United States. Since the United States has a much larger population and geographic size than Australia, the COE thresholds established in the United States are not likely to be applicable to the Australian healthcare context. In addition, it is likely that factors other than volume, such as expertise and infrastructure, will be more important when considering the centralisation of bariatric procedures in an Australian setting. Given that, in Australia, approximately one in five bariatric procedures are revisions, which are often more challenging than the original procedure, it may be sensible to consider COEs dedicated to performing revision bariatric surgery.

Project Status: Completed

Year Published: 2014

URL for published report: https://www2.health.vic.gov.au/getfile/?sc_itemid=%7b235A23D0-7778-42C3-B28D-030E6BF97BE6%7d&title=Centralisation%20of%20Bariatric%20Surgery%20Policy%20implications

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical

Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900

Contact Name: racs.asernip@surgeons.org

Contact Email: racs.asernip@surgeons.org

Copyright: Australian Safety and Efficacy Register of New Interventional Procedures -Surgical (ASERNIP-S)