Broderick Ryan C, Fuchs Hans F, Harnsberger Cristina R, Chang David C, Sandler Bryan J, Jacobsen Garth R, Horgan Santiago
Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA.
Department of Surgery, University of Cologne, Cologne, Germany.
Obes Surg. 2015 Dec;25(12):2231-8. doi: 10.1007/s11695-015-1710-y.
Healthcare costs in the United States (U.S.) are rising. As outcomes improve, such as decreased length of stay and decreased mortality, it is expected that costs should go down. The aim of this study is to analyze hospital charges, cost of care, and mortality in bariatric surgery over time.
A retrospective analysis of the Nationwide Inpatient Sample (NIS) database was performed. Adults with morbid obesity who underwent gastric bypass or sleeve gastrectomy were identified by ICD-9 codes. Multivariate analyses identified independent predictors of changes in hospital charges and in-hospital mortality. Results were adjusted for age, race, gender, Charlson comorbidity index, surgical approach (open versus laparoscopic), hospital volume, and insurance status. In order to estimate baseline surgical inflation, changes in hospital charges over time were also calculated for appendectomy.
From 1998 to 2011, 209,106 patients were identified who underwent bariatric surgery. Adjusted in-hospital mortality for bariatric surgery decreased significantly by 2003 compared to 1998 (p < 0.001, OR 0.47, 95 % CI 0.22-0.92) and remained significantly decreased for the remainder of the study period. As such, a 60-80 % decrease in mortality was maintained from 2003 to 2010 compared to 1998. After adjusting for inflation, the cumulative increase in hospital charges per day of a bariatric surgery admission was 130 % from 1998 to 2011. Charges per stay increased by 2.1 % annually for bariatric surgery compared to 5.5 % for appendectomy.
In-hospital mortality rate following bariatric surgery underwent a ninefold decrease since 1998 while maintaining surgical inflation costs less than appendectomy. Innovation in bariatric surgical technique and technology has resulted in improvement of outcomes while providing overall cost savings.
美国的医疗保健成本正在上升。随着治疗效果的改善，如住院时间缩短和死亡率降低，预计成本应该会下降。本研究的目的是分析随着时间推移，减肥手术的医院收费、护理成本和死亡率。
对全国住院样本（NIS）数据库进行回顾性分析。通过ICD-9编码识别接受胃旁路手术或袖状胃切除术的病态肥胖成年人。多变量分析确定了医院收费和住院死亡率变化的独立预测因素。结果根据年龄、种族、性别、Charlson合并症指数、手术方式（开放手术与腹腔镜手术）、医院规模和保险状况进行了调整。为了估计基线手术通胀，还计算了阑尾切除术随时间的医院收费变化。
1998年至2011年，共识别出209,106例接受减肥手术的患者。与1998年相比，2003年减肥手术的调整后住院死亡率显著下降（p < 0.001，OR 0.47，95%CI 0.22 - 0.92），并且在研究期的剩余时间内一直显著下降。因此，与1998年相比，2003年至2010年死亡率维持下降了60% - 80%。在调整通胀因素后，1998年至2011年减肥手术住院每天的医院收费累计增加了130%。减肥手术每次住院收费每年增加2.1%，而阑尾切除术为5.5%。
自1998年以来，减肥手术后的住院死亡率下降了九倍，同时手术通胀成本低于阑尾切除术。减肥手术技术和工艺的创新在降低总体成本的同时改善了治疗效果。
