Marc Michalsky, MD - 2024 Pediatric Bariatric Surgery Update Course

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.

The Centers of Excellence framework was designed to identify programs providing comprehensive standardized care with long-term follow-up and to compile patient outcomes in a national registry.

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 their separate accreditation programs, with Robin Blackstone leading the merger and championing pediatric inclusion.

MBSAQIP was released in 2014 and has undergone multiple iterations since then.

The MBSAQIP framework and ASMBS best practice guidelines informed the recent AAP policy statement and clinical practice guidelines on pediatric bariatric surgery.

There are currently 958 MBSAQIP-accredited programs in 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, with approximately 500 cases predicted for 2023 based on extrapolation.

MBSAQIP accreditation requires institutions to commit to providing resources and equipment necessary for safe and timely care.

Every MBSAQIP-accredited center receives risk-adjusted institutional-specific data analysis reports on a biquarterly basis.

Risk-adjusted outcome reports inform required quality improvement projects using PDSA or QI framework.

At Nationwide Children's Hospital, an ERAS quality improvement project resulted in reduced hospital length of stay and reduced opioid use.

Age less than 18 is cited as the most common reason for bariatric surgery denials.

Major payers require MBSAQIP accreditation for adult bariatric surgery programs.

It is unclear whether major payers will require MBSAQIP accreditation for pediatric programs in the future.

The American Academy of Pediatrics has made bariatric surgery a widely disseminated therapeutic paradigm through recent policy statements and guidelines.

There are high-volume pediatric bariatric surgery centers that remain unaccredited by MBSAQIP.

The speaker has personal experience with patients being denied bariatric surgery at non-MBSAQIP accredited institutions and subsequently receiving care at his accredited center.

Some children's hospitals do not freely provide the resources required to safely perform bariatric surgery operations.

MBSAQIP accreditation cost is high, but active discussions are underway to accommodate pediatric programs with reduced pricing.