巴西公共卫生系统行政数据库（Datasus）中肥胖症患者行开放型 Roux-en-Y 胃旁路手术的住院时间和 ICU 需求相关变量的横断面研究：基于探索性分析
Cross-sectional study of variables associated with length of stay and ICU need in open Roux-En-Y gastric bypass surgery for morbid obese patients: an exploratory analysis based on the Public Health System administrative database (Datasus) in Brazil.
机构信息
Health Economics and Market Access Department, Johnson & Johnson Medical Brasil, Sao Paulo, Brazil.
出版信息
Obes Surg. 2012 Dec;22(12):1810-7. doi: 10.1007/s11695-012-0695-z.
BACKGROUND
This is an exploratory analysis of potential variables associated with open Roux-en-Y gastric bypass (RYGB) surgery hospitalization resource use pattern.
METHODS
Cross-sectional study based on an administrative database (DATASUS) records. Inclusion criteria were adult patients undergoing RYGB between Jan/2008 and Jun/2011. Dependent variables were length of stay (LoS) and ICU need. Independent variables were: gender, age, region, hospital volume, surgery at certified center of excellence (CoE) by the Surgical Review Corporation (SRC), teaching hospital, and year of hospitalization. Univariate and multivariate analysis (logistic regression for ICU need and linear regression for length of stay) were performed.
RESULTS
Data from 13,069 surgeries were analyzed. In crude analysis, hospital volume was the most impactful variable associated with log-transformed LoS (1.312 ± 0.302 high volume vs. 1.670 ± 0.581 low volume, p < 0.001), whereas for ICU need it was certified CoE (odds ratio (OR), 0.016; 95% confidence interval (CI), 0.010-0.026). After adjustment by logistic regression, certified CoE remained as the strongest predictor of ICU need (OR, 0.011; 95% CI, 0.007-0.018), followed by hospital volume (OR, 3.096; 95% CI, 2.861-3.350). Age group, male gender, and teaching hospital were also significantly associated (p < 0.001). For log-transformed LoS, final model includes hospital volume (coefficient, -0.223; 95% CI, -0.250 to -0.196) and teaching hospital (coefficient, 0.375; 95% CI, 0.351-0.398). Region of Brazil was not associated with any of the outcomes.
CONCLUSIONS
High-volume hospital was the strongest predictor for shorter LoS, whereas SRC certification was the strongest predictor of lower ICU need. Public health policies targeting an increase of efficiency and patient access to the procedure should take into account these results.
背景
这是一项探索性分析，旨在研究与开放式 Roux-en-Y 胃旁路（RYGB）手术住院资源利用模式相关的潜在变量。
方法
基于行政数据库（DATASUS）记录的横断面研究。纳入标准为 2008 年 1 月至 2011 年 6 月期间接受 RYGB 的成年患者。因变量为住院时间（LoS）和 ICU 需求。自变量为：性别、年龄、地区、医院容量、由外科审查公司（SRC）认证的卓越中心（CoE）进行的手术、教学医院和住院年份。进行了单变量和多变量分析（ICU 需求的逻辑回归和住院时间的线性回归）。
结果
对 13069 例手术的数据进行了分析。在初步分析中，医院容量是与对数转换的 LoS 最相关的变量（1.312±0.302 大容量与 1.670±0.581 小容量，p<0.001），而对于 ICU 需求，是经认证的 CoE（比值比（OR），0.016；95%置信区间（CI），0.010-0.026）。经过逻辑回归调整后，经认证的 CoE 仍然是 ICU 需求的最强预测因素（OR，0.011；95%CI，0.007-0.018），其次是医院容量（OR，3.096；95%CI，2.861-3.350）。年龄组、男性和教学医院也与结果显著相关（p<0.001）。对于对数转换的 LoS，最终模型包括医院容量（系数，-0.223；95%CI，-0.250 至-0.196）和教学医院（系数，0.375；95%CI，0.351-0.398）。巴西地区与任何结果均无关联。
结论
大容量医院是最短 LoS 的最强预测因素，而 SRC 认证是最低 ICU 需求的最强预测因素。针对提高效率和患者获得手术机会的公共卫生政策应考虑这些结果。
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