Elnahas Ahmad, Jackson Timothy D, Okrainec Allan, Austin Peter C, Bell Chaim M, Urbach David R
Department of Surgery (Elnahas, Jackson, Okrainec, Urbach), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Elnahas, Austin, Bell, Urbach), University of Toronto; Institute for Clinical Evaluative Sciences (Austin, Urbach), Toronto, Ont.
CMAJ Open. 2016 Sep 14;4(3):E489-E495. doi: 10.9778/cmajo.20160042. eCollection 2016 Jul-Sep.
In 2009, the Ontario Bariatric Network was established to address the exploding demand by Ontario residents for bariatric surgery services outside Canada. We compared the use of postoperative hospital services between out-of-country surgery recipients and patients within the Ontario Bariatric Network.
We conducted a population-based, comparative study using administrative data held at the Institute for Clinical Evaluative Sciences. We included Ontario residents who underwent bariatric surgery between 2007 and 2012 either outside the country or at one of the Ontario Bariatric Network's designated centres of excellence. The primary outcome was use of hospital services in Ontario within 1 year after surgery.
A total of 4852 patients received bariatric surgery out of country, and 5179 patients underwent surgery through the Ontario Bariatric Network. After adjustment, surgery at a network centre was associated with a significantly lower utilization rate of postoperative hospital services than surgery out of country (rate ratio 0.90, 95% confidence interval [CI] 0.84 to 0.97). No statistically significant differences were found with respect to time in critical care or mortality. However, the physician assessment and reoperation rates were significantly higher among patients who received surgery at a network centre than among those who had bariatric surgery out of country (rate ratio 4.10, 95% CI 3.69 to 4.56, and rate ratio 1.84, 95% CI 1.34 to 2.53, respectively).
The implementation of a comprehensive, multidisciplinary provincial program to replace outsourcing of bariatric surgical services was associated with less use of postoperative hospital services by Ontario residents undergoing bariatric surgery. Future research should include an economic evaluation to determine the costs and benefits of the Ontario Bariatric Network.
2009年，安大略省肥胖症网络成立，以满足安大略省居民对加拿大境外肥胖症手术服务激增的需求。我们比较了境外手术接受者与安大略省肥胖症网络内患者术后医院服务的使用情况。
我们使用临床评估科学研究所保存的管理数据进行了一项基于人群的比较研究。我们纳入了2007年至2012年间在境外或安大略省肥胖症网络指定的卓越中心之一接受肥胖症手术的安大略省居民。主要结局是术后1年内安大略省医院服务的使用情况。
共有4852名患者在境外接受了肥胖症手术，5179名患者通过安大略省肥胖症网络接受了手术。调整后，网络中心的手术与术后医院服务利用率显著低于境外手术相关（率比0.90，95%置信区间[CI]0.84至0.97）。在重症监护时间或死亡率方面未发现统计学显著差异。然而，在网络中心接受手术的患者中，医生评估率和再次手术率显著高于境外接受肥胖症手术的患者（率比分别为4.10，95%CI 3.69至4.56，以及率比1.84，95%CI 1.34至2.53）。
实施一项全面的、多学科的省级计划以取代肥胖症手术服务外包，与接受肥胖症手术的安大略省居民术后医院服务使用减少有关。未来的研究应包括经济评估，以确定安大略省肥胖症网络的成本和效益。
