Best Hospitals for Weight-Loss Surgery

A new study shows that the place you choose to have the surgery can make a big difference.

By Gavin Magor July 29, 2008

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If you, like Al Roker, the ever-popular foodie and weather forecaster from NBC, have ever considered the drastic step of having weight-loss surgery, you should read this first for important information about where to go and what to keep in mind.

Weight-loss surgery patients treated at highly rated hospitals have, on average, a 65% lower chance of experiencing serious complications compared with patients who undergo surgery at poorly rated hospitals, according to a study released today by HealthGrades, a leading independent health care ratings organization.

As part of the study, the quality ratings of hospitals performing weight-loss surgery in 17 states became available today at Healthgrades.com.

HealthGrades' third annual Bariatric Surgery Trends in American Hospitals study evaluated bariatric surgical outcomes at every hospital that performed them in 17 states. The study was co-authored by Rick May, M.D., a senior physician adviser.

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Bariatric surgery is a general term describing several types of weight-loss procedures, excluding liposuction.

The study analyzed the outcomes of the most common, including established procedures such as open surgical gastric bypass procedures as well as newer, less-invasive procedures such as "lap-banding" and laparoscopic gastric bypass. Al Roker undertook a gastric bypass operation six years ago.

Gastric bypass surgery patients accounted for the highest rise in complications, increasing 17%. Complications from less-invasive laparoscopic surgery increased by just more than 1%. Complications associated with bariatric surgery include heart attack, kidney failure, stroke and post-surgical infections.

"Laparoscopy lowers complications, especially around the time of the surgery," May says. "With open bypass surgery you can do more complicated procedures." But laparoscopy isn't the best option for all patients -- a surgeon will help figure out which are the best options for each patient.

The HealthGrades study found a significant shift toward laparoscopic bariatric procedures. From 2004 through 2006, open gastric bypass procedures declined by 82%; during the same time period, laparoscopic procedures increased more than fivefold.

May advises that studies suggest that open procedures provide a more effective way to lose weight in the short term and indicate that they are more durable for the long term. Future studies will need to examine the long-term effects of the laparoscopic types of surgery.

Meanwhile, the total volume of bariatric surgical procedures in the U.S. continues to grow rapidly. The American Society for Bariatric Surgery estimates that such surgeries have increased 1,431% in the last decade, to more than 250,000 annually.

Even as the number of surgeries goes up, Dr. May says that only 1% of people who are currently considered morbidly obese are having surgery.

He adds, "The types of surgery are more varied now. They are better, safer and more efficient. As volume increases and more friends and relatives undergo the procedures, the popularity will only increase."

The study found that the complication rate for these surgeries continues to rise, increasing 6% from 2004 to 2006. One possible reason: Lower-volume facilities have higher complication rates.

"The tremendous variation we are seeing in quality among bariatric surgery providers underscores the importance of readily available quality data," May says. "Past performance is a relatively good indicator of the future."

Importance of Ratings

A typical patient having a bariatric surgical procedure at a five-star-rated hospital in one of the 17 states studied has, on average, a 65% lower chance of experiencing one or more in-hospital complications than at a one-star-rated hospital, and a 41% lower chance than at a three-star-rated hospital during 2004 to 2006.

Five-star (top-rated) hospitals performed almost twice the volume of procedures compared with one-star and three-star facilities -- an average of 526 procedures from 2004 through 2006, compared with 266 and 283 respectively.

Higher volume was associated with fewer risk-adjusted complications. Facilities with an annual case volume of 125 procedures or more had the lowest risk-adjusted complications. Facilities performing less than 25 cases per year had the highest rate of risk-adjusted complications.

May says, "The challenge is that more and more surgeons and hospitals are looking at completing bariatric surgery, and they don't necessarily have the experience. Ideally you will see the current good hospitals growing in volume, as more low-volume providers could produce more complications."

If all patients had received their bariatric surgery procedure at five-star hospitals (from 2004 through 2006), 5,125 in-hospital complications could have been potentially avoided in the 17 states studied.

"The highest-risk patients need to find the best possible provider," May says. The American Society for Metabolic and Bariatric Surgery requires its members to have operated as the principal surgeon in a minimum of 25 procedures in a two-year period.

He adds that a patient's primary care physician needs to be involved in providing guidance as to their risk. "It might be high risk to undergo surgery, but for some, the risk of not having the surgery is higher."

HealthGrades Bariatric Surgery Ratings

HealthGrades' quality ratings for bariatric surgery at individual hospitals in 17 states were posted today. Each hospital receives a star rating on the basis of its patient outcomes for bariatric surgery. Hospitals with above-average outcomes receive a five-star rating (93 hospitals). Hospitals with average outcomes receive a three-star rating (263 hospitals), and hospitals with outcomes that are below average receive a one-star rating (99 hospitals).

The study included a total of 154,451 bariatric inpatient surgery procedures performed in 680 hospitals in 17 states from 2004 through 2006. The majority of procedures were performed in four states: New York, Texas, Pennsylvania and California, and the five-star hospitals in those states represented in the top 10% in the country are shown in the table below.

Individuals who are contemplating bariatric surgery will find both quality and cost information at Healthgrades.com. In addition to the free hospital-quality ratings, Web site visitors can also research surgeons who perform bariatric surgery, as well as reports that detail all of the costs, including out-of-pocket expenses, for the procedure.

Al Roker did not have access to these ratings, but the hospital that he selected, Lenox Hill Hospital in New York, is awarded a three-star rating by HealthGrades. You have the advantage of all this research, so don't rely on reputation. These ratings were awarded on objective measurable outcomes.

Hospital	City	State
Pacific Campus Hospital	San Francisco	CA
Kaiser Foundation Hospital Richmond Campus	Richmond	CA
South Coast Medical Center	Laguna Beach	CA
Santa Barbara Cottage Hospital	Santa Barbara	CA
Mercy Medical Center	Rockville Centre	NY
New York University Medical Center-Tisch Hospital	New York	NY
Highland Hospital	Rochester	NY
Westchester Medical Center	Valhalla	NY
Sisters Of Charity Hospital	Buffalo	NY
Arnot Ogden Medical Center	Elmira	NY
St Luke's Roosevelt Hospital	New York	NY
St Catherine Of Siena Hospital	Smithtown	NY
Faxton-St Luke's Healthcare	Utica	NY
Southside Hospital	Bay Shore	NY
Western Pennsylvania Hospital	Pittsburgh	PA
Mercy Jeannette Hospital	Jeannette	PA
Barix Clinics Of Pennsylvania	Langhorne	PA
Geisinger Medical Center	Danville	PA
Pennsylvania Hospital	Philadelphia	PA
Sewickley Valley Hospital	Sewickley	PA
York Hospital	York	PA
Citizens Medical Center	Victoria	TX
United Regional Health Care System	Wichita Falls	TX
Scott And White Memorial Hospital	Temple	TX
Twelve Oaks Medical Center	Houston	TX
Memorial Hermann Hospital	Houston	TX
Spring Branch Medical Center	Houston	TX