To the Editor We read with interest the article titled “Variation in Outcomes at Bariatric Surgery Centers of Excellence” by Ibrahim et al.¹ The study used the Agency for Healthcare Research and Quality administrative state inpatient databases to determine the variation in complication rates within accredited centers in 12 US states.

This study’s Agency for Healthcare Research and Quality data predate the formation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) in 2014 and lack a critical factor for risk adjustment, namely body mass index.¹ Previous studies^2- 4 have demonstrated that accredited centers treat larger, sicker patients with improved outcomes and lowered cost.

致编辑我们感兴趣地阅读了Ibrahim等人的题为“卓越减肥手术中心的结果变化”的文章。¹该研究使用美国医疗保健研究与质量管理局的州住院病人数据库来确定美国12个州认可中心内并发症发生率的变化。

该研究的医疗保健研究与质量机构数据早于2014年新陈代谢和减肥手术鉴定与质量改进计划（MBSAQIP）的形成，并且缺乏风险调整的关键因素，即体重指数。^1周以前的研究^{2 - 4}已经证明，认证中心治疗时，患者病情加重具有改进的结果和降低成本。