Center of Excellence in Specialized Anesthesia - Obesity

In partnership with key opinion leaders and industry professionals, SRC developed the Center of Excellence in Specialized Anesthesia – Obesity (COESA-O) program.  The COESA-O program identifies anesthesiologists who provide excellent care and are dedicated to continuously improving healthcare quality and patient safety.

If you’re interested in accreditation, please complete the Accreditation Program Information Form or contact


Program Requirements

1: Institutional Commitment to Excellence

The applicant facility demonstrates a commitment to excellence in the delivery of anesthesia and related care for obese surgical patients from the highest levels of its medical staff and administration.

2: Surgical Experience

The applicant facility must provide general anesthesia care for at least 200 surgical patients with a BMI > 30 kg/mg² annually.

Each applicant anesthesiologist must have provided general anesthesia care for at least 150 surgical patients with a BMI > 30kg/mg² in their lifetime, and provide general anesthesia care for at least 100 surgical patients annually.

For anesthesiologists, procedures performed at any facility may be used toward volume. Anesthesiologists must have served as the primary anesthesiologist for a procedure to qualify. If the anesthesiologists role as primary anesthesiologist has been properly documented, procedures performed during fellowship may qualify. Cases in which the anesthesiologist served as an assistant do not qualify.

Each procedure used for volume must be thoroughly documented to enable a medical chart review.

Volume waivers may be approved in some circumstances. 

3: Physician Program Director

The applicant facility must appoint a Physician Program Director (or Co-Directors) for the Center of Excellence in Specialized Anesthesia – Obesity (COESA-O) program. The Physician Program Director(s) must:

  • Participate in the relevant decision-making administrative meetings of the facility.
  • Be accredited, or in the process of becoming accredited as a Center of Excellence in Specialized Anesthesia – Obesity (COESA-O) anesthesiologist.
  • Be primarily responsible for coordinating the multidisciplinary services and systems for the delivery of anesthesia for obese surgical patients.
  • Participate in multidisciplinary team meetings.

Multidisciplinary team meetings should be held at least every six months to ensure that decisions related to the delivery of anesthesia for obese surgical patients are addressed in a comprehensive manner. These meetings should include the anesthesia department and involved anesthesiologists and staff to evaluate the anesthetic management of obese surgical patients.

4: Consultative Services

The applicant facility must have an intensive care unit and a full complement of consultative services required for the routine and intensive care of obese surgical patients and their potential complications.

  • During surgery and until discharge from the post-anesthesia care unit (PACU):
    • Anesthesiologist or certified registered nurse anesthetist (CRNA) who supervises anesthesia delivery on all anesthesia for obese surgical patients and is physically present until the patient is discharged from the PACU. Following PACU discharge, the anesthesiologist or CRNA must be available onsite within 30 minutes if needed.
  • Available on site 24/7 (or at all times when patients are present):
    • Physician certified in Advanced Cardiovascular Life Support (ACLS) or equivalent, or an acute response team, at least one of which is ACLS-certified, trained with an established protocol to follow in the event of a sudden respiratory or cardiac event.
  • Available on site within 30 minutes:
    • Physician with critical care credentials to manage complications, specifically a critical care physician/intensivist, hospitalist, cardiologist or pulmonologist
  • The facility is also able to identify the following consultative staff:
    • Cardiologist
    • Endocrinologist
    • Infectious disease specialist
    • Intensivist or equivalent (hospital only)
    • Pulmonologist
    • Radiologist

5: Equipment and Instruments  

The applicant facility must maintain a full line of equipment and surgical instruments to provide appropriate anesthesia care for obese surgical patients. Facilities must have documented training for appropriate staff in the safe operation of this equipment.

If the facility does not have an emergency department or intensive care unit, it must have equipment, such as ventilators and hemodynamic monitoring equipment, necessary to resuscitate and stabilize critically ill patients until they can be transferred to another facility.

6: Anesthesiologist Dedication and Qualified Call Coverage

Each applicant anesthesiologist spends a significant portion of their efforts in the field of anesthesia focused on obese surgical patients and has active, full privileges in anesthesia at the applicant facility.

Each applicant anesthesiologist is board-certified or an active candidate for board certification in anesthesia by the highest certifying authority available.

Each applicant anesthesiologist must complete at least 12 hours of continuing medical education (CME) in anesthesia with a focus on the needs of obese patients every three years. Only American Medical Association Physician’s Recognition Award Category 1 Credits or similar credits from a CME accrediting body outside the United States or three national or international meetings qualify.

The applicant facility has policies in place that require all anesthesiologists to have qualified call coverage, and each applicant certifies that each covering anesthesiologist is capable of identifying and treating obese surgical patients complications. Each covering anesthesiologist is board-certified or an active candidate for board certification in anesthesia by the highest certifying authority available.

7: Clinical Pathways and Standardized Operating Procedures

The applicant formally develops and implements clinical pathways that facilitate the standardization of perioperative anesthesia care for obese surgical patients. The following pathways are required:

  • Preoperative evaluation:
    • Cardio pulmonary system evaluation
    • Preoperative medical management
    • Evaluation of airway and/or obstructive sleep apnea using suitable screening tools, sleep tests and/or use of pressure assisted devices
    • Preoperative multi-disciplinary evaluation
    • Perioperative deep vein thrombosis and antibiotic protocols
  •  Intraoperative:
    • World Health Organization timeout or equivalent
    • Patient transfer and positioning
    • Difficult airway protocol and equipment
    • Standardized anesthesia protocols for methods, agents and monitoring
    • Drug dosing algorithms including calculation of ideal and lean body weights
  •  Postoperative:
    • Postoperative multi modal pain management
    • Assignment to appropriate level of care (critical care, ward or discharge)
    • Nausea prevention and management
    • Regional anesthesia fall prevention protocol

Each applicant anesthesiologist delivers anesthesia in a standardized manner as allowed by variations in operative circumstances.

Each applicant anesthesiologist uses a template for operative note dictation that ensures proper collection of data for procedures.

8: Surgical Team and Support Staff

The applicant facility has ancillary anesthesia staff including one or more classifications of specialty trained personnel including Certified Registered Nurse Anesthetists (CRNAs), Anesthesia Assistants (AAs), physician extenders, nurses and/or operating room technicians to assist the anesthesiologist in delivering excellent anesthesia care to obese surgical patients.

The applicant facility provides ongoing, regularly scheduled staff education in-services to ensure applicable staff have a basic understanding of anesthesia delivery for obese patients and the appropriate management of obese surgical patients. In-service topics must include:

  • Signs and symptoms of common postoperative complications
  • Equipment and surgical instruments
  • Clinical pathways

9: Patient Education

The facility and each applicant anesthesiologist must provide all obese surgical patients with comprehensive preoperative patient education including their anesthesia options and an individualized discussion of projected risks.

The facility and each applicant anesthesiologist must also have a process for obtaining informed consent and selecting procedures that are most appropriate for each patient’s condition.

10: Continuous Quality Assessment

Each applicant anesthesiologist must collect prospective outcomes data on all qualifying patients who undergo anesthesia in SRC’s Outcomes Database (or a similar qualifying database) in a manner consistent with applicable patient privacy and confidentiality regulations. This de-identified data must be available to SRC for initial and renewal inspections or upon request.

Program Fees

Initial Fees

Facility Application Fee: $3,975 USD
Surgeon Application Fee: $650 USD

  • Discounts may be available for surgeons that participate in multiple accreditation programs. Contact SRC for details.
  • Upon payment of application fees, applicants achieve Provisional Status and gain access to SRC’s Outcomes Database at no additional charge.

Site Inspection Fees

Domestic Site Inspection Fee (US, Canada, Mexico): $1,850 USD
International Site Inspection Fee: $5,450 USD

  • The site inspection fee covers a one-day inspection with one site inspector and includes one COE program with up to four co-applicant surgeons. A day will be added to the site inspection for every four additional co-applicant surgeons or each additional COE program. Each additional day is $925.
  • Applicant facilities are responsible for arranging and paying for the site inspector’s hotel, ground transportation and, if needed, an interpreter/translator. These items are not included in the standard site inspection fee.
  • Renewal inspections are required every three years to ensure ongoing program compliance.

Annual Fees

Facility Annual Fee: $3,975 USD
Surgeon Annual Fee: $650 USD

  • Annual participation fees will be billed one year after applicants achieve Provisional Status and each year thereafter.

Fees are subject to change without notice and are not refundable. Payment of required fees does not guarantee accreditation.