Weight Loss Surgery Expert Panel Releases Report on Patient Safety

The Massachusetts Department of Public Health (DPH), in collaboration with the Betsy Lehman Center for Patient Safety and Medical Error Reduction (Lehman Center), announced today that an expert panel convened in February by the Lehman Center has released a comprehensive Executive Report on issues of patient safety in weight loss surgery programs and procedures.

These recommendations include

• Credentialing of facilities and surgeons
• Comparisons of the safety of the various surgical procedures
• Criteria for patient selection and eligibility
• Need for multidisciplinary psychological, nutritional and medical evaluation and treatment
• Patient education and informed consent
• Anesthetic perioperative care and pain management
• Pediatric and adolescent care and eligibility
• Quality assurance and quality improvement resources within facilities
• Data collection needs for the future

Last year, in the wake of several patient deaths, DPH Commissioner Christine Ferguson requested that the Lehman Center convene an expert panel to study weight loss surgical (WLS) programs and procedures as they directly relate to patient safety.     "In the last eight years, we've had a dramatic increase in the number of weight loss surgeries performed in the state," said Commissioner Ferguson. According to Ferguson, more than 2,700 gastric bypass operations were carried out in 2003 compared with fewer than 150 in 1996. "With so many people having these operations," she said, "it was critical that we identify risks and develop standards for safe care."

According to Nancy Ridley, director of the Lehman Patient Safety Center, "This is the first time an Expert Panel has carried out such a comprehensive, in-depth, and systematic review of the entire medical literature related to weight loss surgeries.    Its recommendations will have far-reaching clinical and public health implications, not only for the Commonwealth, but nationwide.   My hope is that it will define the credentials, tools, and procedures required to make best practice the only practice in the care of weight loss surgery patients. Equally important, I hope that this report will enhance public health policies and scientific research in the area of weight loss surgery. Our ultimate goal is to optimize patient safety and promote high quality care."

The expert panel used a state-of-the-art model of evidence-based medicine to make best practice recommendations. After consulting with its stakeholders, the Massachusetts Coalition for the Prevention of Medical Errors (its advisory committee), and sites performing weight loss surgeries in the state, the Lehman Center convened a 24-member Expert Panel.   It included a consumer representative and leading authorities in the fields of obesity treatment, patient safety, nutrition, medical practice, managed care, pediatrics, nursing, and ethics.   It was chaired by Alan M. Harvey, M.D., MBA, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital. George L. Blackburn, M.D., Ph.D., Center for the Study of Nutrition Medicine, Beth Israel Deaconess Medical Center, served as vice chair.

According to Frank Hu, M.D., Ph.D., Lehman Center consulting clinical epidemiologist and associate professor of Nutrition and Epidemiology at the Harvard School of Public Health, panel members collaborated with more than 80 experts in nine task groups to prepare the report. "This document covers every medical discipline involved in weight loss surgery, and every aspect of patient care. It's definitive," he said, noting that the process used to make recommendations is based on published medical literature and expert opinion.

Harvey added the panel and its task groups include "80 percent of the sites performing WLS in the Commonwealth; together, they cover most of the state.   By including so many facilities and practitioners, and by openly sharing this report with all centers performing these procedures, we have established a network for information sharing, benchmarking, and continued improvements in the care of severely obese patients."

Blackburn agreed, but with a caveat. "Gastric restrictive surgery for the treatment of severe obesity started in Boston more than 30 years ago," he said, noting that the Lehman Center report reflects that great wealth of experience. "The focus is on the special needs of those who suffer from obesity; our goal is the safest possible delivery of care—the application of those practices. This report is a great step in that direction."

The Executive Report is a 42-page document, which contains over 100 recommendations from the nine task forces.  The full report can be found at http://www.mass.gov/dph/.