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Marc Michalsky, MD - 2024 Pediatric Bariatric Surgery Update Course
With Dr. Marc Michalsky · hosted by Dr. Todd Ponsky
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Obesity 30 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
In 2004-2005, ASMBS developed a Centers of Excellence framework in response to public and professional concerns related to patient safety in bariatric surgery.
Ken Champion and Walter Porre led a consensus conference in 2004 that addressed bariatric surgery safety issues and published a treatise in 2005.
Centers of Excellence provided a means to identify bariatric surgery programs that provide comprehensive and standardized care and long-term follow-up.
The Centers of Excellence framework served as a way to report and compile patient outcomes within a national registry to assess and verify risks and benefits.
Between 2005 and 2012, major payers declared that authorization for bariatric surgical care needed to be done in accredited centers, in part due to reduction in mortality attributable to national accreditation.
In 2012, ASMBS and ACS combined forces to merge their two separate accreditation programs.
Robin Blackstone led the merging of the two accreditation programs and championed incorporating pediatrics, stating it was the right thing to do.
MBSAQIP was released in 2014 and has undergone a number of iterations over subsequent years.
The MBSAQIP framework and ASMBS best practice guidelines informed the recent American Academy of Pediatrics policy statement and clinical practice guidelines on pediatric bariatric surgery.
There are currently 958 MBSAQIP accredited programs throughout the United States.
109 programs are adult care centers with adolescent designation, representing 11% of all accredited centers.
7 freestanding children's hospitals have MBSAQIP accreditation for adolescent bariatric surgery, representing about 1% of total accredited centers.
Pediatric bariatric surgery volume in the MBSAQIP registry appears to be increasing, approaching 500 cases in 2023 based on extrapolation.
A significant number of high-quality, high-volume pediatric bariatric surgery centers are not part of MBSAQIP.
MBSAQIP accreditation translates into institutional commitment to providing the resources and equipment required to provide safe and timely care.
The centralized MBSAQIP database allows for generation of risk-adjusted institutional-specific data analysis on a bi-quarterly basis.
Risk-adjusted outcome reports inform required quality improvement projects using standard PDSA or QI framework.
ERAS implementation at Nationwide Children's Hospital showed reduced hospital length of stay and reduced opioid use.
Age less than 18 is cited as the most common reason for bariatric surgery insurance denials.
Major payers require MBSAQIP accreditation for adult bariatric surgery programs.
It is uncertain whether major payers will require MBSAQIP accreditation for pediatric bariatric surgery centers in the future.
The American Academy of Pediatrics has made bariatric surgery a widely disseminated therapeutic paradigm through education.
Major payers have been asked to pay attention to the AAP guidelines on pediatric bariatric surgery.
Patients have been denied bariatric surgery coverage by payers because the institution was not MBSAQIP accredited, even for pediatric cases.
Some children's hospitals do not freely provide the resources required to set up a safe bariatric surgery service.
MBSAQIP accreditation requires hospitals to commit to making all required equipment and resources available, which costs money.
The MBSAQIP application price is high, but active discussions are underway to accommodate pediatric programs and reduce the cost.