Original CommunicationSurgical volume impacts bariatric surgery mortality: A case for centers of excellence
Section snippets
Data
Data on gastric bypass surgery performed in the Commonwealth of Pennsylvania between 1999 and 2003 were obtained from the Pennsylvania Health Care Cost Containment Council (PHC4). PHC4 is an independent state agency responsible for monitoring the quality and cost of health care, as well as improving access.19 The PHC4 data set contains hospital discharge data for all Pennsylvania hospitals. Variables included patient demographics (age, gender, race), admission and discharge diagnoses, surgical
Results
The total number of hospitals providing gastric bypass surgery grew from 119 in 1999 to 168 in 2001, and then declined to 114 in 2003 (Fig 1). Although the number of hospitals declined, the average volume of the remaining hospitals increased throughout the period. As seen in Fig 2, the average bariatric surgical volume of Pennsylvania hospitals grew from around 30 cases per year in 1999 to almost 120 per year in 2003. With the exception of the years 1999–2000, both the in-hospital and 30-day
Discussion
The Institute of Medicine (IOM), The Leapfrog Group, and others have identified medical errors as an important cause of preventable death in hospitals across the United States.12, 24 Physicians and other health care providers are under increasing pressure to develop systems of health care delivery that minimize potentially preventable complications. The epidemic of obesity and the rapid growth of bariatric surgery in the U.S. have focused attention on outcomes in bariatric surgery patients, and
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