Understanding Bariatric Accreditation and PROMs

Why Accreditation MattersOver 40% of adults in the U.S. are affected by obesity, increasing the likelihood of developing health issues like type 2 diabetes, heart disease, liver disease, and kidney disease. Weight loss is a key factor in reducing the risk of these problems. Despite efforts through diet and exercise, individuals, especially those with severe obesity, may struggle to achieve lasting results. In such cases, bariatric surgery emerges as a potential solution.

Advancements in bariatric surgery have made it less invasive, safer, and more prevalent. In 2021, over 260,000 bariatric surgeries were conducted in the United States, as reported by the American Society for Metabolic and Bariatric Surgery (ASMBS). However, it’s important to note that the procedure still carries inherent risks, which is why accreditation is so important. At the forefront of bariatric accreditation is MBSAQIP.

What is MBSAQIP?

In the landscape of bariatric surgery, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) plays a crucial role, ensuring rigorous standards for patient care. Let’s dive into the core elements of MBSAQIP.

The MBSAQIP oversees both inpatient and outpatient surgery centers in the United States and Canada. These centers voluntarily undergo a rigorous peer evaluation, emphasizing a commitment to meeting or surpassing national bariatric surgical standards. As a Quality Program jointly administered by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery (ASMBS), MBSAQIP operates at the forefront of ensuring excellence in bariatric care.

The program’s impact is substantial, with accreditation extending to over 900 centers across the United States and Canada. Additionally, MBSAQIP’s influence extends globally, with international centers actively participating as Data Collection Centers who report data to the program. In total, the MBSAQIP captures data from over 200,000 bariatric cases annually.

Why Accreditation Matters

Research underscores the significance of accreditation, with a study in Surgical Endoscopy (July 2013) revealing that in-hospital mortality rates at accredited centers were over three times lower compared to non-accredited counterparts (0.06% vs. 0.22%). Similarly, an October 2012 publication in the Journal of the American College of Surgeons demonstrated nearly identical trends in mortality rates between accredited and non-accredited academic metabolic and bariatric surgery centers (0.06% vs. 0.21%, respectively). 

Accreditation Options and Volume Thresholds in MBSAQIP: Navigating the Bariatric Landscape

Understanding the various accreditation options within the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) is vital for centers aiming to achieve and maintain high standards in bariatric care. Each accreditation option comes with specific volume thresholds, tailoring the requirements to the center’s focus and capabilities.

• MBSAQIP Comprehensive Center | Volume Requirement: A minimum of 50 stapling procedures annually, catering exclusively to adult patients.
• MBSAQIP Comprehensive Center with Adolescent Qualifications | Volume Requirement: A minimum of 50 stapling procedures annually, serving both adult and adolescent patients.
• MBSAQIP Comprehensive Center with Obesity Medicine Qualifications | Volume Requirement: A minimum of 50 stapling procedures annually, focusing on adult patients.
• MBSAQIP Comprehensive Center with Adolescent and Obesity Medicine Qualifications | Volume Requirement: A minimum of 50 stapling procedures annually, accommodating both adult and adolescent patients.
• MBSAQIP Low Acuity Center | Volume Requirement: A minimum of 25 bariatric procedures annually, with adherence to Low Acuity Center Patient and Procedure Selection. This option is designed exclusively for adult patients.
• MBSAQIP Adolescent Center | Volume Requirement: A minimum of 15 stapling procedures annually
• MBSAQIP Ambulatory Surgery Center | Volume Requirement: A minimum of 25 bariatric procedures annually, following the guidelines outlined in Ambulatory Surgery Center Patient and Procedure Selection.. This accreditation option is tailored for adult patients.

Accreditation Process: Navigating the Path to Excellence

The accreditation journey with MBSAQIP involves a streamlined process designed to ensure centers meet rigorous standards in bariatric care. The initial steps include an online application where centers determine their eligibility and designation level. Following the submission, the center undergoes a Pre-Review Questionnaire (PRQ) stage, requiring compliance with applicable standards. A surgeon Site Visit Reviewer is then assigned for an on-site evaluation within six months of PRQ submission. Simultaneously, the MBS Clinical Reviewer initiates online training and data entry into the MBSAQIP Registry. The outcome is communicated approximately 8-12 weeks post-site visit, with accreditation effective retroactively from the site visit date, lasting for a 3-year term. Centers maintain accreditation through Annual Compliance Reports (ACR) at the first and second anniversary and a renewal application every three years, ensuring a continual commitment to quality care.

Shared Decision-Making: The Surgical Risk/Benefit Calculator

A pivotal outcome of the MBSAQIP is the Surgical Risk/Benefit Calculator. This powerful tool, fueled by data from over 775,000 surgeries across 955 MBSAQIP centers (January 1, 2015, to December 31, 2019), equips metabolic and bariatric surgeons with precise, patient-specific information. The calculator, focusing on 20 predictors like age and BMI, forecasts the likelihood of nine outcomes within the initial 30 days post-surgery, from surgical site infections to mortality.

MBSAQIP PROMs

The MBSAQIP PROMs program employs the Patient-Reported Outcomes Measurement Information System (PROMIS) 10-Item Global Health Survey as a comprehensive general health measure, covering essential aspects of patients’ overall well-being. Disease-specific assessments within this program utilize two key instruments:

Obesity-Related Problems Scale (OP): This scale, aimed at measuring the psychosocial impact of obesity, consists of 8 items on a 4-point scale. Aggregated scores are then transformed into a 0-100 scale with higher scores indicating more psychosocial dysfunction. 

Obesity and Weight-Loss Quality of Life Instrument (OWLQOL): Comprising 17 items on a 7-point scale, the OWLQOL offers a nuanced understanding of the quality of life associated with weight loss. Scores are totaled and transformed into a 0-100 scale, with higher scores indicating an improved quality of life post-weight loss.

Other PROMs in Bariatrics: Expanding Perspectives Beyond MBSAQIP

While MBSAQIP focuses on specific PROMs tailored for its program, the broader landscape of bariatric care incorporates additional instruments to capture diverse aspects of patient experiences. Notable among these is the BODY-Q, a tool that measures patient perceptions of weight loss and body contouring. The Medical Outcomes ShortForm 36, a well-validated generic measure, covers core health domains such as physical functioning and mental health, offering a comprehensive perspective on patient well-being. The Beck Depression Inventory (BDI), the Three-factor Eating Questionnaire, and Weight-related Symptoms Measures (WRSM) provide additional options for bariatric PROs.