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INTRODUCTION
More than half of the U.S.A. population is overweight. One third
of it is classified as obese. Obesity is now considered an epidemic
in this country and others, predominantly in minority ethnic
and low socio-economic groups. Obesity in children and adolescents
increased two-fold in the last decades.
Morbid obesity, also known as clinically
severe obesity, is a major public health risk throughout the
developed world. In the U.S.A. alone, an estimated 5 to 10 million
people suffer from this chronic, incurable disease. After smoking,
it is the second most preventable disease causing death. Approximately
300, 000 Americans die every year, and millions more suffer,
due to obesity-related co-morbidities. These include, but are
not limited to, hypertension, cardiac disease, dyslipidemia,
diabetes mellitus type 2, stroke, sleep apnea and other respiratory
disorders, arthritis of weight-bearing joints, gallbladder disease,
gastro-esophageal reflux, stress urinary incontinence, infertility
and hormonal imbalances, skin disorders, and some types of cancer.
Depression, low self-esteem, societal rejection
and prejudice, lesser work and income opportunities, marital,
familiar, social and sexual problems add to the burden of the
morbidly obese. Approximately $100 billion is spent annually
in the United States for the treatment of these obesity-related
diseases. An almost equal amount is spent yearly in diets and
low-calorie foods and drinks, exercise programs and other weight
loss treatments which, even if successful, offer only temporary
relief.
RATIONALE
Bariatric surgeons, like those in other sub-specialty areas,
need to demonstrate a baseline experience and exposure to the
discipline's unique cognitive, technical, and administrative
challenges. The following guidelines define the degree of experience,
exposure, and support considered minimally acceptable credentials
for general surgeons to be eligible for hospital privileges to
perform bariatric surgery.
APPLICANTS FOR HOSPITAL PRIVILEGES
Applicants can be divided into
five categories:
- Those with established credentials to
perform open bariatric surgery.
- Those with established credentials to
perform open and laparoscopic bariatric surgery.
- Those who can document at least 25 open
and laparoscopic bariatric surgical procedures during their general
surgery residency (within the past three years).
- Those trained in approved fellowships
and as first assistants of an experienced bariatric surgeon.
- Those who do not fall into any of the
above categories.
If an individual has credentials to perform
bariatric surgery at an accredited facility on the date of this
document, but does not meet the conditions stated in "Global
Credentialing Requirements" below, the surgeon will be given
the opportunity to comply with the new requirements by the next
re-appointment date.
GLOBAL CREDENTIALING REQUIREMENTS
To meet the Global Credentialing Requirements in bariatric
surgery the applicant should:
- Have credentials at an accredited facility
to perform gastrointestinal and biliary surgery.
- Document that he or she is working within
an integrated program for the care of the morbidly obese patient
that provides ancillary services such as specialized nursing
care, dietary instruction, counseling, support groups, exercise
training, and psychological assistance as needed.
- Document that there is a program in place
to prevent, monitor and manage short-term and long-term complications.
- Document that there is a system in place
to provide follow-up for all patients, with the expectation that
at least 50 % of the patients who receive restrictive procedures
and 75% of those with malabsorptive operations will be seen,
on a regular basis, for at least five years.
PROVISIONAL BARIATRIC SURGERY PRIVILEGES
Provisional bariatric surgery privileges are conferred to
facilitate the pursuit of full bariatric surgical credentials.
With this classification, it is appropriate for the surgeon
to schedule bariatric cases if the Global Credentialing Requirements
and these additional conditions are met:
- The successful completion of a bariatric
training course of at least two days which includes both didactic
and hands-on laboratory work involving cadavers, and
- Documentation of three proctored cases
in which the assistant is a fully trained bariatric surgeon,
or
- Completion of an approved preceptorship
program.
OPEN BARIATRIC SURGERY PRIVILEGES
To obtain "open" bariatric surgery privileges,
the surgeon must meet the Global Credentialing Requirements and:
- Document three proctored cases in which
the assistant is a fully trained bariatric surgeon, and
- Document the successful outcomes (with
acceptable peri-operative complications rates) for 10 open bariatric
surgical cases performed by the applicant.
LAPAROSCOPIC BARIATRIC SURGERY PRIVILEGES
To obtain laparoscopic bariatric surgery privileges the surgeon
must meet the Global Credentialing Requirements and:
- Have privileges to perform "open"
bariatric surgery at an approved facility.
- Have privileges at the given facility
to perform advanced laparoscopic surgery.
- Document three proctored cases in which
the assistant is a fully trained bariatric surgeon, and
- Document the outcomes of 15 laparoscopic
bariatric surgical cases performed as primary surgeon, demonstrating
an acceptable peri-operative complication rate.
It is recommended that the local facility
review the surgeon's outcome data within 6 months of initiation
of a new program and at regular intervals thereafter, to evaluate
patient safety comparable to published outcome benchmarks. In
addition, the surgeon should continue to meet Global Credentialing
Requirements for bariatric surgery at the time of reappointment.
Continuing medical education and active participation in surgical
societies related to this field is also strongly recommended.
DISCLAIMER
The American Society for Bariatric
Surgery (ASBS) is established as an educational professional
medical society. It is not intended to be, nor should it be
viewed as a credentialing body. The above recommendations are
collected and collated based on members' experience and are offered
only as guidelines and are specifically not intended to establish
a local, regional or national standard of care for any bariatric
surgical procedure. While the ASBS views these Guidelines as
being important to successful surgical outcomes, it does not
warrant, guarantee or promise that compliance or non-compliance
with these guidelines assures positive or negative surgical outcomes
for any single procedure.
Established 01/03
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