Department of Surgery, Rush University Medical Center, Chicago, IL; Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL.
Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Electronic address: https://twitter.com/smaasarani.
Surgery. 2022 Feb;171(2):447-452. doi: 10.1016/j.surg.2021.06.023. Epub 2021 Jul 21.
Vertical sleeve gastrectomy is one of the most common bariatric procedures worldwide, but the impact of social determinants of health on postoperative outcomes for this procedure has not been well characterized. The objective of this study was to analyze the impact that social determinants of health have on postoperative outcomes after vertical sleeve gastrectomy.
This was a population-based study using the MARINER-15 database, an all-payer claims database. The primary endpoint of this study was the development of any complication, including cardiac complication, acute kidney injury, deep vein thrombosis, wound complication, hematoma, pneumonia, pulmonary embolism, transfusion, or urinary tract infection within 60 days, 30- and 90-day all-cause mortality, or readmission within 30 or 90 days in patients undergoing vertical sleeve gastrectomy procedures.
Individuals in the social determinants of health cohort had a significantly longer length of stay when compared with those without social determinants of health (3.07 days vs 1.582 days, P < .001). These patients were more likely to develop any complication within 60 days after surgery (hazard ratio 1.20, 95% confidence interval 1.03-1.40) but were less likely to return for readmission within 30 and 90 days (hazard ratio 0.80, 95% confidence interval 0.66-0.96; hazard ratio 0.85 95% confidence interval 0.72-0.99).
Vertical sleeve gastrectomy is an effective treatment for morbid obesity and its associated comorbidities. Although patients with social determinants of health are more likely to develop any of the analyzed postoperative complications within 60 days, they are less likely to return for readmission, highlighting the importance of focused follow-up and other measures to avoid lapses in care and eliminate further barriers to care in this population.
垂直袖状胃切除术是全球最常见的减肥手术之一，但健康的社会决定因素对该手术术后结果的影响尚未得到很好的描述。本研究的目的是分析健康的社会决定因素对垂直袖状胃切除术术后结果的影响。
这是一项基于人群的研究，使用了 MARINER-15 数据库，这是一个所有支付者索赔数据库。本研究的主要终点是在 60 天内发生任何并发症，包括心脏并发症、急性肾损伤、深静脉血栓形成、伤口并发症、血肿、肺炎、肺栓塞、输血或尿路感染，30 天和 90 天全因死亡率，或接受垂直袖状胃切除术的患者在 30 天或 90 天内再次入院。
与没有健康社会决定因素的患者相比，社会决定因素队列中的个体住院时间明显更长（3.07 天比 1.582 天，P<.001）。这些患者在手术后 60 天内发生任何并发症的可能性更高（风险比 1.20，95%置信区间 1.03-1.40），但在 30 天和 90 天内再次入院的可能性较低（风险比 0.80，95%置信区间 0.66-0.96；风险比 0.85，95%置信区间 0.72-0.99）。
垂直袖状胃切除术是治疗病态肥胖及其相关合并症的有效方法。尽管有社会决定因素的患者在 60 天内更有可能发生任何分析的术后并发症，但他们再次入院的可能性较低，这突出了关注随访和其他措施的重要性，以避免在这一人群中出现护理失误，并消除进一步的护理障碍。
