How many sleeve gastrectomies are done at nonaccredited centers in Texas?

Background: The American College of Surgeons created the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to improve the safety of surgery and track outcomes of patients undergoing metabolic and bariatric surgery. The MBSAQIP captures all surgical procedures performed at accredited centers (AC) but not all metabolic and bariatric surgery cases performed in the United States. Texas has a large statewide administrative database that tracks nearly all surgical procedures performed in the state and we proposed using this database to assess the number of sleeve gastrectomies (SG) and whether they were performed at an AC or not.

Objective: Our objective was to determine the percentage of SG that are performed in MBSAQIP ACs.

Setting: University surgical department, United States.

Methods: The Texas Inpatient and Outpatient Public Use Data Files (PUDF) for the year 2017 were examined. We used the Current Procedural Terminology and International Classification of Diseases version 10 codes for SG, 43775 and 0 DB64 Z3, respectively. We compared the PUDF facility list to a list of MBSAQIP ACs in Texas.

Results: There were 4549 SG performed in Texas in 2017 reported in the Outpatient PUDF. Of these, 80.8% of cases were performed at ACs. Of the 136 facilities in the outpatient PUDF performing SG, 58 were MBSAQIP accredited. In the Inpatient PUDF for 2017 there were 11,287 SG, of which 9829 (87%) were performed at ACs. Of 153 centers performing SG, 77 were MBSAQIP accredited. There was a higher percentage of adjustable band conversions to SG at non-ACs in the Outpatient PUDF than the Inpatient PUDF.

Conclusion: The MBSAQIP database is missing almost 20% of outpatient SG performed in Texas and 13% of inpatient SG. Administrative databases can be used to externally validate the MBSAQIP.