Nguyen Ninh T, Hohmann Samuel, Slone Johnathan, Varela Esteban, Smith Brian R, Hoyt David
Department of Surgery, University of California, Irvine Medical Center, Orange, 92868, USA.
Arch Surg. 2010 Jan;145(1):72-8. doi: 10.1001/archsurg.2009.228.
To compare the outcomes of Medicare beneficiaries who underwent bariatric surgery within 18 months before and after implementation of the national coverage determination (NCD) for bariatric surgery.
Analysis of the University HealthSystem Consortium database from October 1, 2004, through September 31, 2007.
A total of 102 academic medical centers and approximately 150 of their affiliated hospitals, representing more than 90% of the nation's nonprofit academic medical centers.
Medicare and Medicaid patients who underwent bariatric surgery to treat morbid obesity.
Demographics, length of stay, 30-day readmission, morbidity, observed-to-expected mortality ratio, and costs.
A total of 3196 bariatric procedures were performed before and 3068 after the NCD. After the implementation of the NCD, the volume of gastric banding doubled and the proportion of laparoscopic gastric bypass increased from 60.0% to 77.2%. Patients who underwent bariatric surgery after the NCD benefited from a shorter length of stay (3.5 vs 3.1 days, P < .001) and lower overall complication rates (12.2% vs 10.0%, P < .001), with no significant differences in the in-hospital mortality rates (0.28% vs 0.20%). Among Medicare patients, there was a 29.3% reduction in the number of bariatric procedures performed within the first 2 quarters after the NCD. However, the number of procedures returned to baseline volume within 1 year and exceeded baseline volume after 2 years of the NCD.
The bariatric surgery NCD resulted in improved outcomes for Medicare beneficiaries without limiting access to care for individuals with medical disability.
比较在减肥手术全国覆盖判定（NCD）实施前后18个月内接受减肥手术的医疗保险受益人的结局。
对2004年10月1日至2007年9月31日的大学卫生系统联盟数据库进行分析。
共有102家学术医疗中心及其约150家附属医院，占全国非营利性学术医疗中心的90%以上。
接受减肥手术以治疗病态肥胖的医疗保险和医疗补助患者。
人口统计学、住院时间、30天再入院率、发病率、观察到的与预期的死亡率以及费用。
在NCD实施前共进行了3196例减肥手术，实施后进行了3068例。NCD实施后，胃束带手术量翻倍，腹腔镜胃旁路手术的比例从60.0%增加到77.2%。NCD实施后接受减肥手术的患者住院时间缩短（3.5天对3.1天，P<.001），总体并发症发生率降低（12.2%对10.0%，P<.001），院内死亡率无显著差异（0.28%对0.20%）。在医疗保险患者中，NCD实施后的前两个季度内进行的减肥手术数量减少了29.3%。然而，手术数量在1年内恢复到基线水平，NCD实施2年后超过了基线水平。
减肥手术NCD改善了医疗保险受益人的结局，同时没有限制医疗残疾患者获得医疗服务的机会。
