Bariatric Surgery Review Committee
Program Requirements Update
April 15, 2008
The
Bariatric Surgery Review Committee (the “Committee”) meets approximately once
per month to discuss issues arising in the site inspection and application
review process for the various Bariatric Surgery Center of Excellence
programs. The Committee issues clarifications of and interpretive guidelines
for the basic program requirements as needed. The Committee may also recommend
additional program requirements or changes to existing requirements. Proposed substantive changes to the existing requirements will be posted for public comment and must be approved by SRC’s Board of Directors and the Executive Council of the American Society for Metabolic and Bariatric Surgery (ASMBS). All the members of the Committee are bariatric surgeons and members of ASMBS.
The following are the clarifications and interpretive guidelines adopted by the Committee from July 2007 through February 2008. Guidelines are effective immediately unless otherwise noted.
All Programs
Requirement Two: Recognized Procedures Qualifying for Volume Requirements
Internal Hernia Repairs
The Committee reconsidered its earlier decision and determined that internal hernia repairs are now counted in determining whether an applicant meets the applicable volume requirements. Particular types of internal hernias which are counted include jejuno-jejunostomy, colonic mesentery and Peterson hernias and hernias forming around an adhesion.
Inguinal, incisional, umbilical and port site hernia repairs do not count toward the volume requirements.
Sleeve Gastrectomy
At the Committee's request, the ASMBS Executive Council recently considered whether sleeve gastrectomy should be considered a recognized procedure for purposes of counting toward the volume requirements. The Executive Council reviewed the request following the principles of the ASMBS Position Statement on Sleeve Gastrectomy issued in June 2007. The consensus of the Executive Council was that the position statement remained valid and there was not sufficient data to justify changes to the statement at this time, but that the statement will be evaluated as new data is published. The Executive Council recommended that the Committee include sleeve gastrectomy as a bariatric procedure which counts toward the volume requirements - provided the procedure is being performed in accordance with the principles set forth in the ASMBS position statement.
Following the Executive Council's recommendation, the Committee is formulating working guidelines to aid in the evaluation of programs performing the sleeve gastrectomy. The guidelines will be announced as soon as they are finalized.
To view the ASMBS Position Statement on sleeve gastrectomy, click here.
Reminder
Note on Recognized Procedures: Only bariatric surgical procedures formally recognized by the ASMBS are counted in determining whether an applicant meets the applicable volume requirements. This standard applies to both surgeon and hospital applicants. The following procedures, whether performed open or laparoscopic, are formally recognized by ASMBS as of June 2003:
- Gastric
Bypass (short or long limbed, transected or not transected, banded or not
banded)
- Vertical
Banded Gastroplasty
- Gastric
Banding
- Duodenal
Switch
- Biliopancreatic
Diversion
Sleeve gastrectomy is a procedure which counts toward the volume requirements if performed within the principles of the ASMBS Position Statement on Sleeve Gastrectomy as discussed above.
Within the context of the surgical procedures recognized by ASMBS, the Committee has also determined that repair of a slipped gastric band and repairs of jejuno-jejunostomy, colonic mesentery, Peterson hernias and hernias forming around an adhesion are bariatric procedures which are counted toward the volume requirements.
Port revisions, tubing repairs, gastric band removals and repairs of inguinal, incisional, umbilical and port site hernias are not primary bariatric procedures and are not counted toward the volume requirements.
Requirement
Two: Fast-track Minimum Volumes
Under the Fast-track process a non-BSCOE hospital may apply with a BSCOE surgeon for Full Approval if the hospital performs at least 63 bariatric cases within the prior six-month period. The hospital may be granted Full Approval after a site inspection if it reasonably appears that the 125 minimum case volume requirement will be achieved by the end of one year. The Committee has clarified that in order to apply for Fast-track review the BSCOE surgeon must have performed at least 25 bariatric procedures at the applicant hospital.
Requirement Six: Covering Surgeons
The Committee clarified that a covering surgeon needs to be available onsite within 30 minutes of request.
Requirement Eight: Bariatric Coordinators
The Committee previously determined that effective December 1, 2007, an applicant's bariatric coordinator must be a licensed health care professional. Centers that were designated as BSCOEs prior to December 1, 2007, whose bariatric coordinators are not licensed health care professionals, may be considered for approval on renewal of their initial BSCOE term provided the coordinator meets one of the following:
- The bariatric coordinator has been continuously employed by the applicant as a bariatric coordinator performing the required duties for at least three (3) years prior to the application; or
- The bariatric coordinator has been continuously employed as a bariatric coordinator in a bariatric surgery practice or institution performing the required duties for at least five (5) years prior to the application; or
- The bariatric coordinator has a bachelor’s degree from an accredited institution and at least three (3) years of clinical work experience in the field of bariatric surgery.
Centers designated as BSCOEs prior to December 1, 2007, may only rely on the preceding exception for renewal of their initial term.
Program Requirements Updates are normally published twice per year. The previous update is dated September 2007 and is available for viewing here.
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