Livingston Edward H
Veterans Affairs North Texas Health Care System, Dallas, Texas, USA.
Surg Obes Relat Dis. 2007 Jan-Feb;3(1):14-20; discussion 20. doi: 10.1016/j.soard.2006.10.009. Epub 2006 Dec 27.
Administrative databases have increasingly been used to assess bariatric surgery outcomes, resulting in policy recommendations about bariatric practice. However, surgical outcomes must be risk adjusted to compare patients of varying potential risk fairly with those to whom the policies will apply. To date, the risk adjustment tools used for database analysis of bariatric surgical outcomes have been those designed for other purposes, and their sensitivity for bariatric outcomes has not been established.
Bariatric surgical procedures contained in the National Hospital Discharge Summary for 1993-2003 were assembled into a database. The standard set of Elixhauser co-morbidity variables used by the Agency for Healthcare Research and Quality were entered into the database. Those variables that were significantly associated with adverse outcomes were entered into a stepwise-elimination logistic regression equation, yielding a set of variables related to adverse outcomes from bariatric surgery. These were then prospectively applied to another database (the National Inpatient Survey) to determine their sensitivity for predicting outcomes and were compared with the commonly used Charlson score.
The variables significantly correlating with bariatric adverse events included chronic pulmonary disease, hypertension, diabetes with chronic complications, fluid and electrolyte disorders, deficiency anemias, and depression. Age and male gender were also signficantly related to adverse events. The c-index (a correlative index, with .5 showing no, and 1, a perfect, relationship) for bariatric surgery mortality with the Charlson index is .52. For the Elixhauser-based system we developed, it is .72.
We have developed a new risk-adjustment tool for bariatric surgery outcomes studies that use administrative databases. Its performance was clearly better than that of the commonly used Charlson co-morbidity score. Bariatric studies that have used the Charlson index should not be considered adequately risk adjusted.
行政数据库越来越多地用于评估减肥手术的结果，从而产生了有关减肥手术实践的政策建议。然而，手术结果必须进行风险调整，以便公平地比较不同潜在风险的患者与政策适用的患者。迄今为止，用于减肥手术结果数据库分析的风险调整工具是为其他目的设计的，其对减肥手术结果的敏感性尚未确定。
将1993 - 2003年国家医院出院摘要中包含的减肥手术程序汇编成一个数据库。医疗保健研究与质量局使用的埃利克斯豪泽共病变量标准集被输入数据库。那些与不良结果显著相关的变量被输入逐步消除逻辑回归方程，得出一组与减肥手术不良结果相关的变量。然后将这些变量前瞻性地应用于另一个数据库（国家住院病人调查），以确定它们预测结果的敏感性，并与常用的查尔森评分进行比较。
与减肥手术不良事件显著相关的变量包括慢性肺病、高血压、伴有慢性并发症的糖尿病、液体和电解质紊乱、缺铁性贫血和抑郁症。年龄和男性性别也与不良事件显著相关。减肥手术死亡率与查尔森指数的c指数（相关指数，0.5表示无关系，1表示完全相关）为0.52。对于我们开发的基于埃利克斯豪泽的系统，该指数为0.72。
我们为使用行政数据库的减肥手术结果研究开发了一种新的风险调整工具。其性能明显优于常用的查尔森共病评分。使用查尔森指数的减肥手术研究不应被认为进行了充分的风险调整。
