Center for Advanced Surgical and Interventional Technology (CASIT), University of California at Los Angeles, Los Angeles, California; Department of Surgery, The George Washington University, Washington, D.C.
Department of Surgery, University of California at Los Angeles, Los Angeles, California.
Surg Obes Relat Dis. 2018 Mar;14(3):368-374. doi: 10.1016/j.soard.2017.11.015. Epub 2017 Nov 21.
Besides rate and extent of weight loss, little is known regarding demographic factors predicting interval cholecystectomy (IC) after bariatric surgery and its incremental costs.
We aim to identify risk factors predicting IC after bariatric surgery and quantify its associated costs.
Nationally representative sampling of acute care hospitals across the United States.
A retrospective cohort study was performed using the National Readmission Database 2010 to 2014. Cox proportional hazard analyses were used to identify risk factors for IC. Linear regression models were constructed to examine associations between cholecystectomy timing and cumulative hospitalization costs.
An estimated national total of 553,658 patients received bariatric surgery during the study period. Of these, 3.3% received concomitant cholecystectomy (CC). After adjusting for bariatric procedure type, age, sex, complication, and length of stay, CC was independently associated with a US$1589 increase in hospitalization cost (95% confidence interval US$1021-2158, P<.01). Of patients that received no CC, only .6% underwent IC during the up to 1-year follow-up. Age<35 (P<.01), female sex (P<.01), and high preoperative body mass index (P = .03) were all risk factors for IC. IC was independently associated with a US$1499 higher cumulative hospitalization cost than CC (P<.01, 95% confidence interval US$844-2154).
Despite the higher absolute cost of IC, its low incidence does not financially justify a routine prophylactic CC approach. In addition, no significant reduction in cholecystectomy-related complications was achieved by performing CC. An individualized approach taking identified risk factors for IC into consideration is recommended when deciding whether to perform prophylactic CC.
除了减重速度和幅度外，关于预测减重手术后间隔期胆囊切除术（IC）的人口统计学因素以及其增量成本的信息知之甚少。
我们旨在确定预测减重手术后 IC 的风险因素，并量化其相关成本。
美国全国范围内急性护理医院的代表性抽样。
使用国家再入院数据库 2010 年至 2014 年进行回顾性队列研究。Cox 比例风险分析用于确定 IC 的风险因素。构建线性回归模型以研究胆囊切除术时机与累积住院费用之间的关联。
在研究期间，估计全国共有 553658 例患者接受了减重手术。其中，3.3%的患者接受了同时性胆囊切除术（CC）。在调整了减重手术类型、年龄、性别、并发症和住院时间后，CC 与住院费用增加 1589 美元独立相关（95%置信区间美元 1021-2158，P<.01）。在未接受 CC 的患者中，只有 0.6%在 1 年的随访期间接受了 IC。年龄<35 岁（P<.01）、女性（P<.01）和高术前体重指数（P =.03）均为 IC 的风险因素。IC 与 CC 相比，累积住院费用高出 1499 美元（P<.01，95%置信区间美元 844-2154）。
尽管 IC 的绝对成本较高，但鉴于其低发生率，常规预防性 CC 方法在经济上并不可行。此外，通过进行 CC 并不能显著降低胆囊切除术相关并发症的发生率。在决定是否进行预防性 CC 时，建议考虑 IC 的风险因素，采取个体化方法。
