Division of Trauma and Acute Care Surgery, University of Louisville Department of Surgery, 550 S. Jackson Street, 2nd Floor Ambulatory Care Building, Louisville, KY, 40202, USA.
Division of Trauma and Acute Care Surgery, WakeMed Raleigh Department of Surgery, Raleigh, NC, USA.
Surg Endosc. 2021 Aug;35(8):4719-4724. doi: 10.1007/s00464-020-07942-5. Epub 2020 Sep 9.
Many operations for complications after bariatric surgery are performed by surgeons without bariatric expertise at centers without teams who routinely care for bariatric patients. This study sought to evaluate whether bariatric expertise affects patterns of care and perioperative outcomes among patients undergoing operative intervention for complications after bariatric surgery.
Administrative claims data from the Kentucky Office of Health Policy were queried for inpatients undergoing operative intervention for complications related to bariatric surgery between 2015 and 2018. Patients were stratified with respect to whether or not they underwent surgery at a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) accredited bariatric surgery center (BCE) or not (non-BCE). Groups were compared with respect to demographic, procedural, and outcome variables.
BCE patients were more often Caucasian than non-BCE patients (p < 0.001) and have either private insurance or Medicare coverage (p = 0.02). Regarding operative approach, operations were more likely to be performed laparoscopically in BCE (88.5% BCE vs. 80.9% non-BCE, p = 0.007). Length of stay was significantly shorter for BCE patients (median 2 days BCE vs. 3 days non-BCE, p < 0.001), and BCE patients were more likely to be discharged home (85.4% BCE vs. 78.5% non-BCE, p = 0.02). Inpatient mortality and average total charges per patient did not differ significantly between the two groups CONCLUSIONS: Surgical management of complications after bariatric surgery at BCE is associated with greater utilization of minimally invasive techniques, shorter hospital stay, and increased likelihood of routine home discharge. These findings should prompt a review and standardization of care patterns for patients with complications after bariatric surgery aimed at optimizing outcomes and improving value.
许多减重手术后并发症的手术是由没有减重手术专业知识的外科医生在没有常规治疗减重患者团队的中心进行的。本研究旨在评估接受减重手术后并发症手术干预的患者中，减重手术专业知识是否会影响治疗模式和围手术期结果。
从肯塔基州卫生政策办公室的行政索赔数据中查询了 2015 年至 2018 年间因与减重手术相关的并发症而接受手术干预的住院患者。根据患者是否在接受代谢和减重手术认证和质量改进计划（MBSAQIP）认证的减重手术中心（BCE）或不在（非 BCE）接受手术，对患者进行分层。比较两组患者的人口统计学、程序和结果变量。
BCE 患者比非 BCE 患者更常为白人（p < 0.001），并且有私人保险或医疗保险（p = 0.02）。关于手术方法，BCE 中手术更可能采用腹腔镜（BCE 中 88.5% vs. 非 BCE 中 80.9%，p = 0.007）。BCE 患者的住院时间明显更短（中位数 2 天 BCE 与 3 天非 BCE，p < 0.001），并且 BCE 患者更有可能出院回家（85.4% BCE 与 78.5%非 BCE，p = 0.02）。两组患者的住院死亡率和每位患者的平均总费用无显著差异。
在 BCE 进行减重手术后并发症的手术管理与微创技术的更多应用、住院时间缩短和常规出院的可能性增加相关。这些发现应该促使对减重手术后并发症患者的护理模式进行审查和标准化，旨在优化结果并提高价值。
