Dallal Ramsey M, Datta Tejwant, Braitman Leonard E
Department of Surgery, Division of Bariatric Surgery, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania 19027, USA.
Surg Obes Relat Dis. 2007 Nov-Dec;3(6):592-6. doi: 10.1016/j.soard.2007.08.009. Epub 2007 Oct 23.
The outcomes of Medicare patients undergoing bariatric surgery have been particularly scrutinized, especially with the Center of Medicare and Medicaid Services' decision to offer bariatric surgery benefits.
The length-of-stay (LOS) data were analyzed from the National Hospital Discharge Survey from 2002 to 2004. To test the hypothesis that Medicare and Medicaid beneficiaries were more likely to have a prolonged length of stay (PLOS), we used a multivariate logistic regression model controlling for age, gender, hospital size, and year of procedure.
An estimated 312,000 bariatric procedures were performed nationally from 2002 to 2004. The average patient age was 41.5 years (range 14-75) and 83.6% were women. The in-hospital mortality rate was reported to be .17%. A PLOS occurred in 3.7% of the population. The Medicare and Medicaid beneficiaries represented 5.7% and 6.2% of the population, respectively. The Medicare beneficiaries were 6.0 times (95% confidence interval 2.5-14; P <.001) as likely to have a PLOS, and Medicaid beneficiaries were 3.2 times (95% confidence interval 1.2-8.9; P = .02) as likely to have a PLOS as others after controlling for age, gender, hospital size, and year of procedure. For every 10-year increase in age, the risk of a PLOS increased by 30% (P <.012).
Medicare and Medicaid beneficiaries are both at an increased risk of a PLOS. This study was not designed to identify the potential causes of a PLOS. Data from prospectively collected bariatric registries might aid surgeons in assessing the risk/benefit ratio of surgical interventions in groups regarded as high risk.
接受减肥手术的医疗保险患者的治疗结果受到了特别审查，尤其是在医疗保险和医疗补助服务中心决定提供减肥手术福利之后。
分析了2002年至2004年全国医院出院调查中的住院时间（LOS）数据。为了检验医疗保险和医疗补助受益人的住院时间延长（PLOS）可能性更高这一假设，我们使用了多变量逻辑回归模型，对年龄、性别、医院规模和手术年份进行了控制。
2002年至2004年全国共进行了约31.2万例减肥手术。患者平均年龄为41.5岁（范围14 - 75岁），83.6%为女性。报告的院内死亡率为0.17%。3.7%的人群出现了PLOS。医疗保险和医疗补助受益人分别占总人群的5.7%和6.2%。在控制了年龄、性别、医院规模和手术年份后，医疗保险受益人出现PLOS的可能性是其他人的6.0倍（95%置信区间2.5 - 14；P <.001），医疗补助受益人出现PLOS的可能性是其他人的3.2倍（95%置信区间1.2 - 8.9；P =.02）。年龄每增加10岁，PLOS的风险增加30%（P <.012）。
医疗保险和医疗补助受益人出现PLOS的风险均增加。本研究并非旨在确定PLOS的潜在原因。前瞻性收集的减肥手术登记数据可能有助于外科医生评估被视为高风险群体的手术干预的风险/收益比。
