Because of the increased utilization of laparoscopic adjustable gastric banding (LAGB) and the performance of these procedures in an outpatient setting, Surgical Review Corporation (SRC), in collaboration with the American Society for Metabolic and Bariatric Surgery (ASMBS), has developed a freestanding outpatient Bariatric Surgery Centers of Excellence® program.

In considering the parameters of the program, SRC's Bariatric Surgery Review Committee recognized that patients treated in a freestanding outpatient Bariatric Surgery Center of Excellence (BSCOE) should carry surgical risk levels appropriate to the outpatient setting. Some of the general program requirements are:

• The program requirements define a low-risk patient as less than 60 years old with a BMI of less than 55, weight under 425 pounds, and an American Society of Anesthesiologists classification of less than 4, with no prior history of deep venous thrombosis or pulmonary embolism.
  
  
• Outpatient procedures are limited to those which do not involve stapling or division of the gastrointestinal tract.
  
  
• An outpatient facility must perform a minimum of 100 cases per year.
  
  
• Outpatient centers located less than one mile from or on the same campus as a tertiary care facility may apply with the inpatient facility.
  
  
• Surgery centers that are located further than one mile away from a tertiary care facility must apply to this program.
  
  
  • There must be a formal transfer agreement to a tertiary care facility; however, that facility does not have to be a SRC Bariatric Surgery Center of Excellence.
    
    
  • The transfer facility must cooperate with a site inspection to examine furniture, equipment and inpatient charts of all bariatric surgery patients transferred to or hospitalized in their facility subsequent to the surgery in the applicant freestanding center.
    
    
• Site inspectors must be allowed to interview staff at the transfer facility.
  
  
• Application fees to become a freestanding BSCOE are the same as the hospital-based BSCOE program.

The outpatient program may be expanded in the future as additional procedures which can be safely performed in an outpatient setting are developed and approved by the FDA. In the meantime, the ASMBS and SRC believe that the freestanding BSCOE program is an important next step in ensuring the delivery of bariatric surgical care with the highest levels of efficacy, efficiency and safety.