Dallal Ramsey M, Bailey Linda, Guenther Lauren, Curley Coleen, Sergi Frank
Albert Einstein Healthcare Network, Philadelphia, Pennsylvania 19027, USA.
Surg Obes Relat Dis. 2008 Mar-Apr;4(2):110-4. doi: 10.1016/j.soard.2007.04.007. Epub 2007 May 25.
Risk adjustment is a critically important aspect of outcomes research. Racial, geographic, cultural, and socioeconomic differences are nonclinical parameters that can affect clinical outcomes measurement after gastric bypass surgery.
A single surgeon's experience with 217 consecutive laparoscopic gastric bypass patients in private practice in Southern California was compared with the same surgeon's experience with 124 consecutive patients in an academic institution in Philadelphia.
Of the Southern California and Philadelphia groups, 89%, 1%, 9%, and 1% and 55%, 38%, 6%, and 0% were white, black, Hispanic, and Asian, respectively. The average number of co-morbidities was 7.8 in the Southern California group versus 14.4 in the Philadelphia group (P <.001). The 60-day readmission to the hospital rate and emergency room admission rate was 1.4% versus 10.4% and 1.4% versus 18.5%. The insurer mix of private pay, private insurer, and federally funded insurer was 20%, 80%, and 0% in the Southern California group and 0.8%, 71%, and 28% in the Philadelphia group, respectively. Multivariate logistic regression analysis found Medicaid status and practice location independently predicted for the 60-day readmission rate (odds ratio [OR] 3.7, P = .04 and OR 5.6, P = .04, respectively) and a return to the emergency room (OR 3.2, P = .03 and OR 16.3, P <.001). Race, income, and the presence of diabetes were not independent predictors. Variables with nonsignificant differences between the Southern California and Philadelphia cohorts included average age, average body mass index, and major complications (return to surgery and intensive care unit admissions).
The results of this study have shown that in comparing and predicting the outcomes after bariatric surgery, adjustment for demographic and insurance variables might be necessary to improve accuracy.
风险调整是结果研究的一个至关重要的方面。种族、地理、文化和社会经济差异是非临床参数，可影响胃旁路手术后临床结果的测量。
将一位外科医生在南加州私人诊所连续治疗的217例腹腔镜胃旁路手术患者的经验，与该外科医生在费城一所学术机构连续治疗的124例患者的经验进行比较。
在南加州组和费城组中，白人、黑人、西班牙裔和亚裔分别占89%、1%、9%和1%以及55%、38%、6%和0%。南加州组的平均合并症数量为7.8，而费城组为14.4（P<.001）。60天再入院率和急诊室入院率分别为1.4%对10.4%以及1.4%对18.5%。南加州组自费、私人保险公司和联邦资助保险公司的保险商构成分别为20%、80%和0%，而费城组分别为0.8%、71%和28%。多因素逻辑回归分析发现，医疗补助状态和执业地点分别独立预测60天再入院率（优势比[OR]3.7，P=.04和OR 5.6，P=.04）以及返回急诊室的情况（OR 3.2，P=.03和OR 16.3，P<.001）。种族、收入和糖尿病的存在不是独立预测因素。南加州组和费城组队列之间无显著差异的变量包括平均年龄、平均体重指数和主要并发症（再次手术和重症监护病房入院）。
本研究结果表明，在比较和预测减肥手术后的结果时，可能需要对人口统计学和保险变量进行调整以提高准确性。
