Impact of Center Accreditation Level on Laparoscopic Bariatric Surgery Outcomes: A Retrospective Cohort Study.

INTRODUCTION

Accreditation systems are designed to standardize surgical care and improve outcomes in bariatric surgery, yet evidence on the effects of accreditation transitions within a single center is scarce. This study evaluated whether achieving Center of Excellence (COE) status influenced postoperative safety and perioperative process measures in a high-volume bariatric unit.

METHODS

A retrospective cohort study was conducted using prospectively collected data from the German national registry (StuDoQ|MBE). All consecutive patients undergoing laparoscopic bariatric surgery at a single high-volume German bariatric Center between January 2018 and November 2025 were included. Patients were grouped by accreditation era (non-COE vs. COE). The primary outcome was any intraoperative or 30-day postoperative complication graded as Clavien–Dindo grade ≥ II. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR).

RESULTS

A total of 2,760 patients were analyzed (2,114 non-COE; 646 COE). Baseline characteristics were largely comparable except for ASA distribution. Overall complication rates were low and identical between eras (1.9% vs. 1.9%, p > 0.9). COE status was not associated with decreased complication risk after adjustment (aOR 1.07, 95% CI 0.52–2.02, p = 0.71). Operative time (median 39 vs. 40 min, p < 0.001) and extended LOS (5.5% vs. 0.8%, p < 0.001) significantly decreased during COE accreditation. Adhesiolysis was more frequently performed in the COE than in the non-COE (5.7% vs. 3.4%, p < 0.001).

CONCLUSION

Transition to COE accreditation did not change 30-day complication rates and coincided with a reduction in LOS and operative time, suggesting improved perioperative efficiency without compromising safety despite increased procedural complexity.