I'm not a huge fan of this drive to designate hospitals as a "Center of Excellence" in some surgical sub-specialty. Bariatrics was the first to champion the idea. On the surface it sounds super-duper. Center of Excellence! That's where i want my surgery! Obtaining such designation, however, usually requires jumping through multiple hoops and making sure all the boxes are checked on an application form. It doesn't hurt to be affiliated with an institution that that can afford to fund the added resources required to meet the prerequisites. The emphasis is less on outcome measures, more on program compliance. For instance, a bariatric program needs to document that they have nutritionists, weight loss specialists, specialized equipment for the operating room and afterwards, and other ancillary services available for potential patients.
It seems like a good idea but now we're starting to see a push for other kinds of surgery to be restricted to such designated "Centers of Excellence". Some surgeons (i.e. academic ivory tower big shots) would like to restrict operations like Whipples and advanced laparoscopic procedures (colon resections, Nissens) to the big tertiary referral centers. Isn't that nice. Let all the community surgeons handle the gallbladders and hernias and butt pus. We'll handle the big cases, they say. Despite the fact that volume actually correlates poorly with reduced morbidity in major operations like pancreatic resections. Other factors like quality of the individual surgeon, nursing staff, and chracteristics of the hospital where the surgery is performed contribute to outcomes as well. Volume is sometimes an arbitrary number.
Anyway, I do actually like this idea. (See page 7 of the link) General surgeons in the Boston area have agreed to take the Fundamentals in Laparoscopic Surgery (FLS) exam in order to maintain laparoscopic operating privileges at hospitals such as Massachusetts General and Beth Israel Deaconess. Basically you show up, take a written exam, and then have to perform a series of timed maneuvers using a laparoscopic training module. Meritocracy in the purest sense. If you have the goods, the skills, then you get to stay in the game. Doesn't matter whether you practice at a vaunted "Center of Excellence" or not. It's based entirely on individual performance and proficiency. Now there are some things I dont like about the FLS test. For instance, moving a bunch of rubber balls from one cup to another or being able to tie a knot in a piece of styrofoam does not necessarily translate into real life excellence. It's like drafting a quarterback based on how fast they can run the 40 yard dash and how many footballs they throw through a tire in a 60 second period. Surely we can do better than rubber balls and styrofoam bowels. Perhaps an in vivo exam on an animal would be a better indicator..... just don't tell PETA.