Center of Excellence in Metabolic & Bariatric Surgery
The Center of Excellence in Metabolic and Bariatric Surgery (COEMBS) program is a global patient safety and quality improvement program available to all bariatric surgeons and facilities around the world. The COEMBS program reflects the specific needs of obese patients and the unique roles and responsibilities of bariatric and metabolic surgery providers.
Truly excellent patient care is the result of both the individual surgeon and the facility where the surgery is performed. The COEMBS accreditation is therefore awarded to a facility and its associated surgeons who have successfully completed the accreditation process, which enables patients to distinguish providers who have met the requirements for delivering high-quality perioperative and long-term follow-up care from those who have not.
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1: Institutional Commitment to Excellence
The applicant facility demonstrates a commitment to excellence in metabolic and bariatric surgery from the highest levels of its medical staff and administration.
This commitment includes having specialty-specific credentialing and privileging guidelines in bariatric surgery that are separate from general surgery guidelines.
2: Surgical Experience
The applicant facility performs at least 80 metabolic and bariatric surgery procedures annually.
Each applicant surgeon has served as the primary surgeon for at least 125 metabolic and bariatric surgery procedures in their lifetime, and performs at least 50 procedures annually.
For surgeons, procedures performed at any facility may be used toward volume. Surgeons must have served as the primary surgeon for a procedure to qualify. If the surgeon’s role as primary surgeon has been properly documented, procedures performed during fellowship or residency may qualify. Cases in which the surgeon served as co-surgeon or assisting surgeon 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.
The following procedures are the only primary procedures that qualify:
- Gastric bypass: short- or long-limbed, transected or not transected, banded or not banded
- Gastric banding: includes procedures in which the Allergan LAP-BAND® is used in patients with Class I obesity (BMI of 30-35) and at least one comorbidity
- Duodenal switch
- Biliopancreatic diversion
- Sleeve gastrectomy
- Single-Anastomosis Gastric Bypass
The following procedures, whether open or laparoscopic, also qualify when performed on bariatric surgery patients:
- Conversion to a primary procedure listed above
- Removal of a slipped or eroded gastric band
- Replacement of a slipped or eroded gastric band
- Gastric band repositioning
- Gastrojejunostomy repair/revision
- Enteroenterostomy repair/revision
- Altering the length of the common channel
- Altering the length of the Roux limb
- Gastric pouch revision
- Reversal of gastric bypass, vertical banded gastroplasty, intestinal bypass, biliopancreatic diversion and duodenal switch procedures
- Re-sleeving for weight gain or sleeve dilation
- Removal of a Fobi/Capella band
- Revision or repair of a perforated marginal gastrojejunal ulcer
Procedures that do not qualify include:
- Gastric band port revisions, including port/tubing removal, replacement and repositioning
- Removal of a gastric band for reasons other than slippage or erosion
- Gastric stoma plication
- Repairs of inguinal, incisional, hiatal, umbilical and port-site hernias; colonic mesentery; Petersen’s hernias; and hernias forming around an adhesion
- Therapeutic endoscopic procedures used to dilate the esophagus
- Diagnostic procedures
Applicants are required to meet the following outcomes benchmarks, which were established using SRC’s Outcomes Database and validated through a review of the metrics used in payer-based quality programs:
- Overall mortality for all bariatric surgery procedures performed at the applicant facility: ≤1.2% at 90 days
- Mortality for the primary procedure performed at the facility (based on volume):
- Gastric bypass: ≤0.6% at 90 days
- Sleeve gastrectomy: ≤0.4% at 90 days
- Gastric banding: ≤0.2% at 90 days
- Overall mortality for all bariatric surgery procedures performed by each applicant surgeon: ≤1.2% at 90 days
- Mortality for the primary procedure performed by each applicant surgeon (based on volume):
- Gastric bypass: ≤0.6% at 90 days
- Sleeve gastrectomy: ≤0.4% at 90 days
- Gastric banding: ≤0.2% at 90 days
- Complications: ≤10% at 90 days
- Readmissions: ≤8% at 90 days
- Reoperations: ≤5% at 90 days
3: Physician Program Director
The applicant facility must appoint a Physician Program Director (or Co-Directors) for the Center of Excellence in Metabolic & Bariatric Surgery (COEMBS) 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 Metabolic & Bariatric Surgery (COEMBS) surgeon.
- Be primarily responsible for coordinating the multidisciplinary services and systems for bariatric surgery.
- Participate in multidisciplinary team meetings.
Multidisciplinary team meetings should be held at least quarterly to ensure that decisions related to bariatric surgery are addressed in a comprehensive manner.
4: Consultative Services
The applicant facility must have a full complement of consultative services required for the routine and intensive care of bariatric surgery 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 bariatric surgery 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:
- Interventional radiologist or other physician capable of performing inferior vena cava filter placement and percutaneous drainage of intra-abdominal abscess
- Physician capable of performing endoscopies to diagnose complications
- 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:
- Infectious Disease Specialist
- Nursing program manager
- Psychiatrist/mental health provider
5: Equipment and Instruments
The applicant facility must maintain a full line of equipment and surgical instruments to provide appropriate perioperative care for bariatric surgery 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: Surgeon Dedication and Qualified Call Coverage
Each applicant surgeon spends a significant portion of their efforts in the field of bariatric surgery and has active, full privileges in general and bariatric surgery at the applicant facility.
Each applicant surgeon is board-certified or an active candidate for board certification in their surgical specialty by the highest certifying authority available.
Each applicant surgeon must complete at least 24 hours of continuing medical education (CME) focused on metabolic and bariatric surgery 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 bariatric surgeons to have qualified call coverage, and each applicant surgeon certifies that each covering surgeon is capable of identifying and treating bariatric surgery complications. Each covering surgeon is board-certified or an active candidate for board certification in general surgery by the highest certifying authority available and has admitting privileges at the co-applicant facility.
7: Clinical Pathways and Standardized Operating Procedures
The applicant formally develops and implements clinical pathways that facilitate the standardization of perioperative care for bariatric surgery procedures. The following pathways are required:
- Anesthesia, including monitoring and airway management
- Perioperative care, including monitoring, pain management and airway management
- Deep vein thrombosis (DVT) prevention and management
- Instructions for identification, evaluation and management of early warning signs of complications.
- Preoperative patient preparation, evaluation, patient education, and plan of action for discharge that includes follow-up and any necessary patient education
- Pain Management
- Preoperative multidisciplinary evaluation, education, preparation, admission workup/evaluation and informed consent of the bariatric surgery patient
- Preoperative, postoperative and long-term nutrition regimen
The first three pathways will be deemed satisfied if the facility has accreditation from The Joint Commission (formerly known as JCAHO), DNV-GL or an equivalent healthcare organization approved by SRC.
Each applicant surgeon performs each surgical procedure in a standardized manner as allowed by variations in operative circumstances.
Each applicant surgeon uses a template for operative note dictation that ensures proper collection of data for surgical procedures.
8: Surgical Team and Support Staff
The applicant facility employs nurses and/or physician extenders who provide education and care to patients as well as an operative team trained to care for bariatric surgery patients. The applicant facility also appoints a program coordinator who supervises program development, patient and staff education, multidisciplinary team meetings, and ongoing bariatric surgery program compliance.
The applicant facility provides ongoing, regularly scheduled staff education in-services to ensure applicable staff have a basic understanding of bariatric surgery and the appropriate management of the bariatric surgery patient. 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 surgeon must provide all bariatric surgery patients with comprehensive preoperative patient education.
The facility and each applicant surgeon must also have a process for obtaining informed surgical consent and selecting procedures that are most appropriate for each patient’s condition.
The applicant provides organized and supervised support groups for all patients who may undergo or have undergone bariatric surgery.
10: Continuous Quality Assessment
Each applicant surgeon must collect prospective outcomes data on all patients who undergo bariatric surgery procedures 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.
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.
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.