Importance In the United States, reports about perioperative complications associated with bariatric surgery led to the establishment of accreditation criteria for bariatric centers of excellence and many bariatric centers obtaining accreditation. Currently, most bariatric procedures occur at these centers, but to what extent they uniformly provide high-quality care remains unknown. Objective To describe the variation in surgical outcomes across bariatric centers of excellence and the geographic availability of high-quality centers. Design, Setting, and Participants This retrospective review analyzed the claims data of 145 527 patients who underwent bariatric surgery at bariatric centers of excellence between January 1, 2010, and December 31, 2013. Data were obtained from the Healthcare Cost and Utilization Project’s State Inpatient Database. This database included unique hospital identification numbers in 12 states (Arkansas, Arizona, Florida, Iowa, Massachusetts, Maryland, North Carolina, Nebraska, New Jersey, New York, Washington, and Wisconsin), allowing comparisons among 165 centers of excellence located in those states. Participants were identified usingInternational Classification of Diseases, Ninth Revision, Clinical Modificationcodes. Those included in the study cohort were patients with a primary diagnosis of morbid obesity and who underwent laparoscopic Roux-en-Y gastric bypass, open Roux-en-Y gastric bypass, laparoscopic gastric band placement, or laparoscopic sleeve gastrectomy. Excluded from the cohort were patients younger than 18 years or who had an abdominal malignant neoplasm. Data were analyzed July 1, 2016, through January 10, 2017. Main Outcomes and Measures Risk-adjusted and reliability-adjusted serious complication rates within 30 days of the index operation were calculated for each center. Centers were stratified by geographic location and operative volume. Results In this analysis of claims data from 145 527 patients, wide variation in quality was found across 165 bariatric centers of excellence, both nationwide and statewide. At the national level, the risk-adjusted and reliability-adjusted serious complication rates at each center varied 17-fold, ranging from 0.6% to 10.3%. At the state level, variation ranged from 2.1-fold (Wisconsin decile range, 1.5%-3.3%) to 9.5-fold (Nebraska decile range, 1.0%-10.3%). After dividing hospitals into quintiles of quality on the basis of their adjusted complication rates, 38 of 132 (28.8%) had a center in a higher quintile of quality located within the same hospital service area. Variation in rates of complications existed at centers with low volume (annual mean [SD] procedure volume, 156 [20] patients; complication range, 0.6%-6.4%; 9.8-fold variation), medium volume (annual mean [SD] procedure volume, 239 [27] patients; complication range, 0.6%-10.3%; 17.5-fold variation), and high volume (annual mean [SD] procedure volume, 448 [131] patients; complication range, 0.6%-4.9%; 7.5-fold variation). Conclusions and Relevance Even among accredited bariatric surgery centers, wide variation exists in rates of postoperative serious complications across geographic location and operative volumes. Given that a large proportion of centers are geographically located near higher-performing centers, opportunities for improvement through regional collaboratives or selective referral should be considered.

Objective: To understand the impact of the Hospital Readmission Reduction Program on both future targeted and nontargeted surgical procedures. Background: The Hospital Readmission Reduction Program, established under the Affordable Care Act in March of 2010, placed financial penalties on hospitals with higher than expected rates of readmission beginning in 2012 for targeted medical conditions. Multiple studies have suggested a “spill-over” effect into other conditions, but the extent of that effect for specific surgical procedures is unknown. Methods: A retrospective review 5,122,240 Medicare beneficiaries who underwent future targeted procedures (total hip replacement, total knee replacements) or nontargeted procedures (colectomy, lung resection, abdominal aortic aneurysm repair, coronary artery bypass graft, aortic valve replacement, mitral valve repair) using an interrupted time series model to assess the rates of readmission before the Hospital Readmission Reduction Program was announced (2008–2010), whereas the program was being implemented (2010–2012) and after penalties were initiated (2012–2014). We also explored if the change in readmission rates were correlated with changes in index length of stay, use of observation status, or discharge to a skilled nursing facility. Results: From 2008 to 2014 rates of readmission declined for both target conditions (6.8%–4.8%; slope change −0.07 to −0.10, P < 0.001) and nontarget conditions (17.1%–13.4%; slope change −0.04 to −0.11, P < 0.001). The rate of reduction was most prominent after announcement of the program between 2010 and 2012 for both targeted and nontargeted conditions. During the same time period, mean hospital length of stay decreased; nontargeted conditions (10.4–8.4 days) and targeted conditions (3.6–2.8 days). There was no correlation between hospital reduction in readmissions and use of observation-only admissions (Pearson correlation coefficient = 0.01) or discharge to a skilled nursing facility (Pearson correlation coefficient = 0.05). Conclusions: Trends in readmissions after inpatient surgery are consistent with hospitals responding to financial incentives announced in the Hospital Readmission Reduction Program. There appears to be both an anticipatory effect (future targeted procedures reducing readmission before payments implemented) and a spillover effect (nontargeted procedures also reducing readmissions).

Following the approval of the laparoscopic gastric band to treat morbid obesity by the US Food and Drug Administration (FDA) in 2001,¹ as many as 96 000 devices have been placed annually.² When the gastric band malfunctions (eg, the band erodes into the stomach or slips down and causes obstruction) or the patient has not achieved the expected weight loss, a reoperation is indicated to replace or remove the band. Although these safety and effectiveness concerns have contributed to decreasing the device’s popularity, the American Society for Metabolic and Bariatric Surgery estimates that more than 11 000 devices were placed in 2015.³ In fact, the FDA expanded their indications for the device to patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of more than 30, making an estimated 19 million Americans able to have the gastric band placed who would not be eligible for other bariatric procedures.^4,5

Background/Objectives: This study comprehensively examines how artificial intelligence (AI) technologies are transforming clinical practice in plastic and reconstructive surgery across the entire patient care continuum, with the specific objective of identifying evidence-based applications, implementation challenges, and emerging opportunities that will shape the future of the specialty. Methods: A comprehensive narrative review was conducted analyzing the integration of AI technologies in plastic surgery, including preoperative planning, intraoperative applications, postoperative monitoring, and quality improvement. Challenges related to implementation, ethics, and regulatory frameworks were also examined, along with emerging technological trends that will shape future practice. Results: AI applications in plastic surgery demonstrate significant potential across multiple domains. In preoperative planning, AI enhances risk assessment, outcome prediction, and surgical simulation. Intraoperatively, AI-assisted robotics enables increased precision and technical capabilities beyond human limitations, particularly in microsurgery. Postoperatively, AI improves complication detection, pain management, and outcomes assessment. Despite these benefits, implementation faces challenges including data privacy concerns, algorithmic bias, liability questions, and the need for appropriate regulatory frameworks. Future directions include multimodal AI systems, federated learning approaches, and integration with extended reality and regenerative medicine technologies. Conclusions: The integration of AI into plastic surgery represents a significant opportunity to enhance surgical precision, improve outcome prediction, and expand the boundaries of what is surgically possible. However, successful implementation requires addressing ethical considerations and maintaining the human elements of surgical care. Plastic surgeons must actively engage with AI development to ensure these technologies address genuine clinical needs while aligning with the specialty’s core values of restoring form and function, alleviating suffering, and enhancing quality of life.

Surgeons are under enormous pressure to continually improve and learn new surgical skills. Novel uses of surgical video in the preoperative, intraoperative, and postoperative setting are emerging to accelerate the learning curve of surgical skill and minimize harm to patients. In the preoperative setting, social media outlets provide a valuable platform for surgeons to collaborate and plan for difficult operative cases. Live streaming of video has allowed for intraoperative telementoring. Finally, postoperative use of video has provided structure for peer coaching to evaluate and improve surgical skill. Applying these approaches into practice is becoming easier as most of our surgical platforms (e.g., laparoscopic, and endoscopy) now have video recording technology built in and video editing software has become more user friendly. Future applications of video technology are being developed, including possible integration into accreditation and board certification.

Bariatric surgery leads to changes in mental health, quality of life and social functioning, yet these outcomes differ among individuals. In this study, we explore patients’ psychosocial experiences following bariatric surgery and elucidate the individual-level factors that may drive variation in psychosocial outcomes. Eleven semi-structured focus groups with Michigan Bariatric Surgery Collaborative (MBSC) patients (n = 77). Interviews were audio recorded, transcribed verbatim, and analyzed using a grounded theory approach. Data on participant demographic characteristics were abstracted from the MBSC clinical registry. Most focus group participants were female (89%), white (64%), and married (65%). We identified three major themes: (1) change in self-perception; (2) change in perception by others; and (3) change in relationships. Each theme includes 3 sub-themes, demonstrating a range of positive and negative psychosocial experiences. For example, weight loss led to increased self-confidence among many participants while others described a loss of self-identity. Some noted improved relationships with family or friends while others experienced worsening or even loss of relationships due to perceived jealousy. Weight loss following bariatric surgery leads to complex changes in self-perception and inter-personal relationships, which may be proximal mediators of commonly assessed mental health outcomes such as depression. Individuals considering bariatric surgery may benefit from anticipatory guidance about these diverse experiences, and post-surgical longitudinal monitoring should include evaluation for adverse psychosocial events.