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Quality of Care for Weight Loss Patients
The Cedars-Sinai Weight Loss Center provides a complete range of medical and surgical treatment services for adults ranging from the overweight to the morbidly obese. Center physicians thoroughly evaluate each patient and provide the individualized care that is crucial to effective and long-lasting treatment success. This unique, comprehensive program addresses the medical, behavioral, nutritional, and, if necessary, the surgical and plastic surgical issues related to obesity.
Our program is accredited as a Bariatric Surgery Center of Excellence by the American College of Surgeons. Please see the American College of Surgeons' website for more information.
- Sleeve gastrectomy, in which the surgeon removes a large portion of the stomach, reshaping the stomach into a vertical "sleeve" about the size of a thin banana. The new smaller stomach holds less food and helps a person feel fuller faster. At Cedars-Sinai, this procedure typically requires a one to two day stay in the hospital.
- Roux-en-Y gastric bypass (RYGB), in which the surgeon divides the upper portion of the stomach and creates a small pouch. This means the stomach can hold less food. The surgeon next attaches a section of the small intestine to the pouch so that the food eaten bypasses a portion of the small intestine. It mixes with digestive enzymes further down the digestive tract. As a result, a person is able to eat less and less of the food eaten is absorbed by the body. At Cedars-Sinai, a Roux-en-Y gastric bypass procedure typically requires a one to two day stay in the hospital.
- Laparoscopic adjustable gastric band, in which the surgeon inserts an inflatable silicone band around the upper stomach, tubing and an access port that sit just under the patient's skin. The band creates a new, smaller pouch in the stomach. This means the person can eat less. It also slows down the movement of food through the stomach into the intestines. This means that the person feels fuller sooner. The band can be adjusted by injecting or removing saline solution through the port and tubing into the band. During the first year following surgery, adjustments need to be made every month for the best results. At Cedars-Sinai, laparoscopic adjustable gastric band surgery typically requires a one day stay in the hospital.
Quality of Care Measures for Bariatric Surgery Patients at Cedars-Sinai
At the Cedars-Sinai Weight Loss Center, we follow our surgical volumes and outcomes closely because we want to continually improve. Studies suggest that for many surgical procedures, hospitals that perform high volumes have better quality outcomes, i.e. lower short-term and long term mortality and morbidity. Volume is an indicator of experience, which influences outcomes in multiple ways. In addition to the experience of surgeons in performing specific procedures, high volume hospitals may institute specific care processes that improve outcomes and have the infrastructure dedicated to particular clinical specialties, including related technology and intensive care personnel. Commitment to quality standards throughout the institution is also an important determinant of better outcomes.1,2 In addition, outcomes for high-risk procedures have been shown to be better when performed by more highly-trained surgeons than by general surgeons.3
The table below reflects data on patients who underwent gastric bypass or adjustable gastric band surgical procedures to treat obesity. To measure the quality of care given to patients having this procedure, the Cedars-Sinai Weight Loss Center tracks the indicators in the table below.
|Cedars-Sinai Weight Loss Center 2012 Data Compared to Other Hospitals||Cases||Average Length of Stay||% ICU Cases||Cases with 1 or More Complications||% Deaths|
|Comparison Group||9,358||2.14 days||4.16%||3||0%|
Results for Patients in the Cedars-Sinai Medically Supervised Weight Loss Program
The Cedars-Sinai Weight Loss Center followed the 67 patients who completed at least 3 months of their medically supervised weight loss program between July 1, 2012 and June 30, 2013. The average treatment duration was 11 months. Outcomes for these patients are presented below.
|Average Weight||253 pounds||217 pounds|
|Average Weight Loss||36 pounds|
|Average % of Body Weight Lost||13%|
|Average % of *Excess Weight Lost||37%|
*This is the amount of weight lost as a percentage of the total weight loss required for an individual needed to reach their ideal body weight.
1Bach PB, Ann Intern Med 2009; 150:729-30
2Greene FL, Ann Surg Oncol 2007; 15:14-15
3Kozower BD et al, Ann Thorac Surg 2008; 86:1405-08