From accreditation to outcomes: the evolution and future of quality improvement in bariatric surgery

Bariatric surgery is the most effective intervention for severe obesity and its metabolic comorbidities. Over the last 2 decades, systematic quality improvement (QI) initiatives have transformed the field, leading to enhanced safety and improved outcomes. This review highlights five major QI initiatives-Enhanced Recovery After Surgery (ERAS), participation in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), fellowship training, Accredited Bariatric Centers, and the Focused Practice Designation in Metabolic and Bariatric Surgery. We examine the historical evolution, supporting data, and persistent challenges associated with each. Moving forward, the field must prioritize long-term outcomes and follow-up, procedural consistency and standardization, and equitable access. Expanding follow-up periods for the MBSAQIP, optimizing ERAS for high-risk groups, and further formalizing fellowship training are logical next steps.