Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
Department of Economics, University of Utah, 260 Central Campus Dr. #4100, Salt Lake City, UT, 84112, USA.
Obes Surg. 2021 Jun;31(6):2503-2510. doi: 10.1007/s11695-021-05279-z. Epub 2021 Feb 24.
Risk of nutritional disorders (NDs) in bariatric surgical patients has led to guideline recommendations for pre- and post-operative nutrient deficiency screening. The aim of this study was to identify baseline factors associated with incident NDs and, in addition, to explore possible differences in health care spending and use between patients with and without incident NDs following bariatric surgery.
Using data linked with a state-wide bariatric surgical registry and a state-wide claims database, subjects who underwent bariatric surgery between July 1, 2013, and December 31, 2015, were identified. Incident NDs and health care cost and use outcomes following 1 year from surgery were extracted from the claims data. Logistic regression was used to identify baseline factors associated with incident NDs. Zero-inflated negative binomial regression and generalized linear regression were used to estimate health care cost and use outcomes.
A total of 3535 patients who underwent bariatric surgery were identified. Of these patients, those without continuous health insurance enrollment (n=1880), having prevalent (pre-surgery) NDs (n=461), and missing baseline BMI (n=41) were excluded. Of patients analyzed (n=1153), about 30% had incident NDs, with a mean (SD) age and BMI at surgery of 46 (12) years and 48 (9.2) kg/m, respectively. Patients with one incident ND had higher total health care spending (coefficient=$41118, p-value<0.01) and ED visits (IRR=1.86, p-value<0.01).
Those without pre-operative NDs may have a higher chance of having NDs post-operatively. Taking multivitamins and continues monitoring are necessary to prevent any negative outcomes related to post-operative NDs.
减重手术患者发生营养障碍（NDs）的风险导致了指南推荐对手术前后的营养缺乏进行筛查。本研究旨在确定与术后新发 NDs 相关的基线因素，并探讨术后新发 NDs 患者与无新发 NDs 患者的医疗支出和使用方面的差异。
利用与全州减重手术登记处和全州理赔数据库相链接的数据，确定了 2013 年 7 月 1 日至 2015 年 12 月 31 日期间接受减重手术的患者。从理赔数据中提取术后 1 年新发 NDs 及医疗成本和使用结果。使用逻辑回归确定与新发 NDs 相关的基线因素。使用零膨胀负二项回归和广义线性回归估计医疗成本和使用结果。
共确定了 3535 名接受减重手术的患者。其中，1880 名患者无连续医疗保险参保记录，461 名患者术前（手术前）已患有 NDs，41 名患者缺失基线 BMI，因此排除了这些患者。在分析的患者（n=1153）中，约 30%发生新发 NDs，手术时的平均（SD）年龄和 BMI 分别为 46（12）岁和 48（9.2）kg/m2。新发 1 种 NDs 的患者总医疗支出（系数=$41118，p 值<0.01）和急诊就诊（IRR=1.86，p 值<0.01）更高。
术前无 NDs 的患者术后发生 NDs 的可能性可能更高。术后服用多种维生素和持续监测是预防任何与术后 NDs 相关的不良结局所必需的。
