Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Surg Obes Relat Dis. 2021 Jan;17(1):104-111. doi: 10.1016/j.soard.2020.08.031. Epub 2020 Sep 2.
Current bariatric surgery studies have focused on traditional outcomes such as mortality and morbidity and have thus far have neglected an important marker of surgical care- discharge destination.
The aim of this study was to 1) characterize the prevalence of and clinical characteristics of patients who undergo bariatric surgery with respect to discharge disposition and to 2) evaluate factors which predict alternate care facility (ACF) discharge.
Participating Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) centers.
Data was extracted from the MBSAQIP data registry from 2015 to 2018. All primary Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures were included while prior revisional surgeries and emergency surgeries were excluded. Our primary objective was to characterize the prevalence of and clinical characteristics of patients who undergo bariatric surgery and are discharged to an alternate care facility (ACF). Our secondary outcome was to identify predictors of discharge to an ACF using multivariable logistic regression modeling.
Most patients (n = 588,256; 99.6%) were discharged home while only a small proportion were discharged to an ACF (n = 1502; .4%). Patients discharged to an ACF were older (51.5 ± 13.5 yr versus 44.4 ± 12.0 yr; P < .0001), of increased body mass index (49.7 ± 11.9 kg/m versus 45.3 ± 7.8 kg/m; P < .0001), and more likely to be of male sex (26.8% versus 20.4%; P < .0001). Patients with hypertension (65.2% versus 47.9%; P < .0001), dyslipidemia (40.1% versus 23.7%; P < .0001), sleep apnea (52.7% versus 38.1%; P < .0001), and medication-dependent diabetes (39.5% versus 26.3%; P < .0001) were more likely to be discharged to an ACF. Multivariable logistic regression revealed that partially dependent and dependent functional status were the single greatest preoperative predictors of ACF discharge with an 8- and 7-fold respective increase in odds of ACF versus patients of independent functional status.
Impaired functional status was the single greatest independent preoperative predictor of ACF discharge, providing evidence against the current use of a strict age cut-off criteria and support for implementation of a more patient-centered functional approach in selection of surgical candidates.
目前的减重手术研究集中在死亡率和发病率等传统结果上，迄今为止，一直忽略了手术护理的一个重要标志——出院去向。
本研究旨在：1）描述接受减重手术的患者在出院处置方面的患病率和临床特征，并 2）评估预测替代护理机构（ACF）出院的因素。
参与代谢和减重手术认证和质量改进计划（MBSAQIP）中心。
数据从 2015 年至 2018 年从 MBSAQIP 数据登记处提取。所有原发性 Roux-en-Y 胃旁路术（RYGB）和袖状胃切除术（SG）手术均包括在内，而先前的翻修手术和急诊手术则排除在外。我们的主要目标是描述接受减重手术并被送往替代护理机构（ACF）的患者的患病率和临床特征。我们的次要结果是使用多变量逻辑回归模型确定送往 ACF 的预测因素。
大多数患者（n = 588,256；99.6%）出院回家，只有一小部分患者出院至 ACF（n = 1502；0.4%）。送往 ACF 的患者年龄更大（51.5 ± 13.5 岁与 44.4 ± 12.0 岁；P <.0001），体重指数更高（49.7 ± 11.9 kg/m 与 45.3 ± 7.8 kg/m；P <.0001），更有可能为男性（26.8%与 20.4%；P <.0001）。患有高血压（65.2%与 47.9%；P <.0001）、血脂异常（40.1%与 23.7%；P <.0001）、睡眠呼吸暂停（52.7%与 38.1%；P <.0001）和药物依赖型糖尿病（39.5%与 26.3%；P <.0001）的患者更有可能被送往 ACF。多变量逻辑回归显示，部分依赖和依赖的功能状态是 ACF 出院的唯一最大术前预测因素，与独立功能状态的患者相比，ACF 出院的几率分别增加了 8 倍和 7 倍。
功能状态受损是 ACF 出院的唯一最大独立术前预测因素，这证明了目前使用严格的年龄截止标准是不合理的，并支持在选择手术候选者时实施以患者为中心的更具功能性的方法。
