Doumouras Aristithes G, Saleh Fady, Tarride Jean-Eric, Hong Dennis
Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
Division of General Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
Surg Obes Relat Dis. 2016 Jun;12(5):1023-1031. doi: 10.1016/j.soard.2016.02.016. Epub 2016 Feb 23.
The most significant driver of healthcare utilization for bariatric surgery is the index admission and readmissions within the first 30 days after a procedure. Identifying areas to create efficiencies during this period is essential to decreasing overall healthcare costs.
The objective of the study was to characterize the short-term costs of bariatric surgery within a regionalized center of excellence bariatric care system.
The Ontario Bariatric Network is a regionalized bariatric care system with 4 high-volume Bariatric Centers of Excellence.
We performed a population-based retrospective analysis including all adult patients who received a bariatric surgical procedure in Ontario from April 2009 until March 2012. Total hospital cost and number of days in hospital was calculated for all index admissions and all readmissions within 30 days of a bariatric surgical procedure. An inverse Gaussian generalized linear model was utilized to model the effect of covariates on costs. A Poisson regression was used to determine the effect on covariates on total days in hospital.
After multivariable adjustment, the sleeve gastrectomy procedure decreased costs by $1447 over gastric bypass (95% confidence interval [CI] $1578 to-$1315]); P<.001). This effect increased when adjusting only for preoperative factors with a cost savings of nearly $2000 ($1953) (95% CI-$3250 to-$533; P = .003). Conversely, complications were the major drivers of increased cost as anastomotic leaks added $24,397 (95% CI $20,688-$28,106; P<.001) to healthcare costs. In addition, medical complications, such as respiratory failure/infection ($19,465) (95% CI $11,007-$27,924; P<.001), were also significant cost drivers.
Major drivers of increased resource utilization included major surgical and medical complications, such as anastomotic leaks and respiratory failure/infection. Days in hospital were affected more by medical complications than surgical complications. Sleeve gastrectomy resulted in a clear short-term cost advantage over Roux-en-Y gastric bypass (RYGB), and this was likely related to the procedure itself as opposed to differences across procedures in co-morbidity and complication rates.
减肥手术医疗资源利用的最重要驱动因素是首次住院以及术后30天内的再次住院。在此期间确定提高效率的领域对于降低总体医疗成本至关重要。
本研究的目的是描述在一个区域化的卓越减肥护理中心系统内减肥手术的短期成本。
安大略减肥网络是一个区域化的减肥护理系统，有4个高容量的卓越减肥中心。
我们进行了一项基于人群的回顾性分析，纳入了2009年4月至2012年3月在安大略接受减肥手术的所有成年患者。计算了所有首次住院以及减肥手术后30天内所有再次住院的总住院费用和住院天数。使用逆高斯广义线性模型来模拟协变量对成本的影响。使用泊松回归来确定协变量对总住院天数的影响。
经过多变量调整后，袖状胃切除术比胃旁路手术成本降低了1447美元（95%置信区间[CI]为1578美元至 - 1315美元）；P <.001）。仅根据术前因素进行调整时，这种效果有所增加，成本节约近2000美元（1953美元）（95% CI为 - 3250美元至 - 533美元；P = .003）。相反，并发症是成本增加的主要驱动因素，因为吻合口漏使医疗成本增加了24397美元（95% CI为20688美元至28106美元；P <.001）。此外，医疗并发症，如呼吸衰竭/感染（19465美元）（95% CI为11007美元至27924美元；P <.001），也是显著的成本驱动因素。
资源利用增加的主要驱动因素包括重大手术和医疗并发症，如吻合口漏和呼吸衰竭/感染。住院天数受医疗并发症的影响比手术并发症更大。袖状胃切除术相对于Roux - en - Y胃旁路术（RYGB）具有明显的短期成本优势，这可能与手术本身有关，而不是手术在合并症和并发症发生率方面的差异。
