Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Surg Obes Relat Dis. 2018 May;14(5):631-636. doi: 10.1016/j.soard.2018.01.017. Epub 2018 Feb 2.
Despite a lack of demonstrated patient benefit, many insurance providers mandate a physician-supervised diet before financial coverage for bariatric surgery.
To compare weight loss between patients with versus without insurance mandating a preoperative diet.
University hospital, United States.
Retrospective study of all patients who underwent laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy over a 5-year period, stratified based on whether an insurance-mandated physician-supervised diet was required. Weight loss outcomes at 6, 12, and 24 months postoperation were compared. Linear mixed-models and backward-stepwise selection were used. P<0.05 was considered significant.
Of 284 patients, 225 (79%) were required and 59 (21%) were not required to complete a preoperative diet by their insurance provider. Patients without the requirement had a shorter time to operation from initial consultation (P = .04), were older (P<.01), and were more likely to have government-sponsored insurance (P<.01). There was no difference in preoperative weight or body mass index or co-morbidities. In unadjusted models, percent excess weight loss was superior in the group without an insurance-mandated diet at 12 (P = .050) and 24 (P = .045) months. In adjusted analyses, this group also had greater percent excess weight loss at 6 (P<.001), 12 (P<.001), and 24 (P<.001) months; percent total weight loss at 24 months (P = .004); and change in body mass index at 6 (P = .032) and 24 (P = .007) months. There was no difference in length of stay or complication rates.
Insurance-mandated preoperative diets delay treatment and may lead to inferior weight loss.
尽管没有证明患者受益，但许多保险公司在为减重手术提供财务保障之前，要求医生监督饮食。
比较有保险要求和无保险要求术前饮食的患者之间的减重效果。
美国大学医院。
对 5 年内接受腹腔镜 Roux-en-Y 胃旁路术或袖状胃切除术的所有患者进行回顾性研究，根据是否需要保险要求的医生监督饮食进行分层。比较术后 6、12 和 24 个月的体重减轻结果。使用线性混合模型和逐步向后选择。P<0.05 被认为具有统计学意义。
在 284 名患者中，225 名（79%）需要并完成了保险提供商要求的术前饮食，59 名（21%）不需要。没有该要求的患者从初次咨询到手术的时间更短（P =.04），年龄更大（P<.01），并且更有可能拥有政府赞助的保险（P<.01）。两组患者的术前体重或体重指数或合并症均无差异。在未调整模型中，在没有保险要求饮食的组中，12 个月（P =.050）和 24 个月（P =.045）时的超重百分比减轻更优。在调整分析中，该组在 6 个月（P<.001）、12 个月（P<.001）和 24 个月（P<.001）时也有更高的超重百分比减轻；24 个月时的总体重减轻百分比（P =.004）；以及 6 个月（P =.032）和 24 个月（P =.007）时的体重指数变化。两组患者的住院时间或并发症发生率无差异。
保险要求的术前饮食会延迟治疗并可能导致减重效果不佳。
