Telem Dana A, Yang Jie, Altieri Maria, Patterson Wendy, Peoples Brittany, Chen Hao, Talamini Mark, Pryor Aurora D
*Division of Foregut, Bariatric and Advanced GI Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY †Department of Preventative Medicine, Stony Brook University Medical Center, Stony Brook, NY ‡Office of Quality and Patient Safety, New York State Department of Health, Albany, NY §Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY.
Ann Surg. 2016 May;263(5):956-60. doi: 10.1097/SLA.0000000000001536.
To identify unplanned emergency resource utilization in the perioperative period following bariatric surgery.
Avoidable emergency department (ED) utilization and hospital readmissions pose a significant economic burden to our healthcare system. The extent of this problem is poorly studied in the bariatric literature.
Using New York statewide longitudinal administrative data, 38,776 patients, who underwent primary bariatric surgery from 2010 to 2013, were analyzed. Multiple logistic regression models analyzed all variables with P < 0.05 on univariate models.
The 30-day unplanned ED utilization rate was 11.3% and 30-day hospital readmission rate was 5.3%. ED visits resulted in an inpatient admission 34.9% of the time. In total, 17.5% had 2 or more 30-day unplanned ED presentations. Patients presenting to the ED were more likely to be black, have pulmonary disease, be insured by the Centers for Medicaid and Medicare Services, travel further distances for index procedure, and have a surgical procedure other than gastric banding. In total, 46.7% presented to a nonindex hospital and 32.5% were admitted. Patients presenting to a nonindex hospital were significantly less likely to be admitted than those presenting to an index hospital.
Unplanned perioperative healthcare utilization is a significant burden incurred by the bariatric population. A clear opportunity is identified for improvement in healthcare delivery-particularly for high-risk and high-frequency utilizers. Presentation to nonindex hospitals has important implications to the accuracy of current patient safety and quality outcomes measures. System measures designed to capture all unplanned resource utilization, not just those to index hospitals, are crucial for accurate evaluation.
确定减肥手术后围手术期计划外应急资源的利用情况。
可避免的急诊科（ED）就诊和医院再入院给我们的医疗系统带来了巨大的经济负担。减肥手术文献中对这一问题的研究程度较低。
利用纽约州全州纵向行政数据，分析了2010年至2013年接受初次减肥手术的38776例患者。多个逻辑回归模型分析了单变量模型中P<0.05的所有变量。
30天计划外ED利用率为11.3%，30天医院再入院率为5.3%。ED就诊导致34.9%的时间内患者住院。总计17.5%的患者有2次或更多次30天计划外ED就诊。前往ED就诊的患者更可能是黑人，患有肺部疾病，由医疗补助和医疗保险服务中心承保，前往接受初次手术的距离更远，并且接受的手术不是胃束带手术。总计46.7%的患者前往非初次手术医院就诊，32.5%的患者被收治。前往非初次手术医院就诊的患者被收治的可能性明显低于前往初次手术医院就诊的患者。
围手术期计划外医疗资源利用是减肥人群产生的重大负担。明确存在改善医疗服务的机会，尤其是针对高风险和高频利用者。前往非初次手术医院就诊对当前患者安全和质量结果指标的准确性具有重要影响。旨在捕捉所有计划外资源利用情况的系统措施，而不仅仅是针对初次手术医院的措施，对于准确评估至关重要。
