December 2, 2005

Bariatric surgery program named center of excellence

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William Richards, M.D.

Bariatric surgery program named center of excellence

Vanderbilt's Center for Surgical Weight Loss is being recognized as a Bariatric Surgery Center of Excellence, a fairly new designation from the American Society of Bariatric Surgery (ASBS) designed to promote excellence in the discipline and patient care.

Obesity is a serious epidemic in America, with more than two-thirds of citizens reportedly overweight.

Due to an increase in the number of weight loss surgeries, ASBS membership voted in June 2004 to initiate the Centers of Excellence program and founded the Surgical Review Corporation (SRC) as a separate, not-for-profit agency reviewing applications from centers across the country.

An estimated 50 centers have received the designation, according to SRC Chief Executive Officer Gary Pratt.

“By them satisfactorily meeting tough requirements it demonstrates to their patients that they provide excellent care,” Pratt said.

“The initial numbers we are looking at are very impressive. For centers that have applied the mortality rate is .3 percent, which is lower than a lot of surgeries like cabbages [coronary artery bypass grafts] and other operating procedures common to these patients.”

“Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures,” a study that appeared in the Oct. 19 Journal of the American Medical Association (JAMA), listed 30-day, 90-day and one-year mortality rates at 2.0, 2.8 and 4.6 percent, respectively.

Vanderbilt's outcomes are much lower at 0.2, 0.4 and 0.6 percent, respectively, according to William Richards, M.D., medical director of VUMC's Bariatric Surgery Center.

“I think the whole concept of the Center of Excellence is that there is a recognition that this is a highly complex surgery that requires a great deal of infrastructure and expertise to perform it well and have excellent outcomes,” said Richards, professor of Surgery and director of Laparoendoscopic Surgery.

“This recognition shows that here at Vanderbilt we have created a very good program that has really some outstanding staff of nurse practitioners, dietitians, surgeons, nursing staff and people who help us get these excellent outcomes.”

Richards recognized Bariatric Coordinator Jennifer Ginnings and surgeons Kelly Wright, M.D., associate professor of Surgery; Alfonso Torquati, M.D., assistant professor of Surgery; Willie Melvin, M.D., assistant professor of Surgery; and Mike Holzman, M.D., associate professor of Surgery, for their contributions toward the Center of Excellence designation.

The extensive certification process considers everything from patient outcomes to furniture, hospital equipment, instruments and imaging resources suitable to deal with massive patients who often exceed their ideal body weight by 100 pounds or more.

Vanderbilt's low mortality rates for these complex operations is impressive when considering that patients with severe forms of obesity may also have life-threatening diseases including diabetes, hypertension and severe pulmonary compromise, Pratt said.

Patient volume is increasing at Vanderbilt, according to Richards, with the center on track to perform 420 procedures this fiscal year with an average length of stay (LOS) of 2.4 days.

Vanderbilt performed 278 procedures in 2003 with average length of stay (LOS) of 3.5 days; 334 in 2004 with average LOS of 3 days; and 364 in 2005 with average LOS of 2.7 days.

“Cases are going up but LOS is going down as we perfect the laparoscopic procedures and have gained expertise in the field,” Richards said.