Keto Jessica L, Kemmeter Paul R
Grand Rapids Medical Education and Research Center/Michigan State University General Surgery Residency, 221 Michigan Southeast, Grand Rapids, MI 49503, USA.
Surg Obes Relat Dis. 2008 May-Jun;4(3):437-40. doi: 10.1016/j.soard.2007.11.004. Epub 2008 Jan 28.
To report the effect of the American Society of Bariatric Surgery or American College of Surgeons-designated Centers of Excellence designation in Michigan on our practice trends and patient populations. As of February 2006, weight loss surgery for Medicare beneficiaries are reimbursed when procedures are performed at American Society of Bariatric Surgery or American College of Surgeons-designated Centers of Excellence.
Patients who underwent laparoscopic Roux-en-Y gastric bypass surgery by an individual surgeon from June 1 to October 31 in 2004, 2005, and 2006 were stratified according to use of private third-party insurance versus Medicare (MC) insurance. The demographic data, body mass index, numbers of medications and co-morbidities, operative time, lengths of stay, morbidity, and mortality were analyzed. Significance was assessed at P <.05.
From June 1 to October 31 in 2004, 2005, and 2006, 255 patients with MC or private third-party insurance underwent laparoscopic Roux-en-Y gastric bypass surgery, with the percentage of MC patients increasing from 15.3% and 10.2% in 2004 and 2005 to 30.9% in 2006. The MC patients were older (56.1 +/- 1.3 yr versus 44.1 +/- 0.7 yr; mean +/- standard error of mean), had more co-morbidities (5.1 +/- 0.2 versus 3.5 +/- 0.1), required more medications (10.3 +/- 0.6 versus 5.6 +/- 0.3), had undergone more previous operations (2.1 +/- 0.2 versus 1.3 +/- 0.1), and had longer operative times (148 +/- 11.1 versus 121 +/- 3.1 min) than the private third-party insurance patients; the differences were all significant. The differences in gender, body mass index, and length of stay were not significantly different.
The Centers for Medicare and Medicaid Services requirements for Centers of Excellence designation resulted in a significant increase in the Medicare case load within our institution. This population tended to be older and more complex, with longer operative times. The changes present new challenges in patient care, including the coordination of care for the multiple co-morbidities of older obese patients with a multispecialty care team.
报告美国减肥外科学会或美国外科医师学会指定的密歇根卓越中心认证对我们的业务趋势和患者群体的影响。截至2006年2月，当手术在上述指定卓越中心进行时，医疗保险受益人的减肥手术可获得报销。
将2004年、2005年和2006年6月1日至10月31日期间由同一位外科医生进行腹腔镜Roux-en-Y胃旁路手术的患者，根据是否使用私人第三方保险或医疗保险（MC）进行分层。分析人口统计学数据、体重指数、用药数量和合并症、手术时间、住院时间、发病率和死亡率。显著性评估标准为P <.05。
在2004年、2005年和2006年的6月1日至10月31日期间，255例使用MC或私人第三方保险的患者接受了腹腔镜Roux-en-Y胃旁路手术，其中MC患者的比例从2004年的15.3%和2005年的10.2%增加到2006年的30.9%。MC患者年龄更大（56.1±1.3岁对44.1±0.7岁；平均值±平均标准误差），合并症更多（5.1±0.2对3.5±0.1），需要更多药物（10.3±0.6对5.6±0.3），之前接受过更多手术（2.1±0.2对1.3±0.1），手术时间更长（148±11.1分钟对121±3.1分钟），均与私人第三方保险患者存在显著差异。性别、体重指数和住院时间方面的差异不显著。
医疗保险和医疗补助服务中心对卓越中心的要求导致我们机构内医疗保险病例数量显著增加。这一群体往往年龄更大、情况更复杂，手术时间更长。这些变化给患者护理带来了新的挑战，包括与多专科护理团队协调照顾老年肥胖患者的多种合并症。
