Department of Surgery, University of Colorado Anschutz, Aurora, CO, USA.
Center for Innovative Design and Analysis, Colorado School of Public Health, Aurora, CO, USA.
Surg Endosc. 2022 Nov;36(11):8154-8163. doi: 10.1007/s00464-022-09247-1. Epub 2022 Apr 27.
Use of sleeve gastrectomy (SG) for weight loss has grown exponentially; however, clear indications for SG versus Roux-en-Y gastric bypass (RNYGB) are lacking. Certain populations may be more likely to undergo SG due to its simpler technique and without clear clinical indications. We aim to examine underlying predictors of patients undergoing SG vs RNY across a single state.
We queried the Colorado All Payers Claim Database for patients undergoing laparoscopic SG or RNY. Patient-level variables included patient demographics, comorbidities, distance traveled for surgery, and distressed communities index (DCI), a zip code-based measure of socioeconomic status. Hospital-level variables included annual bariatric surgery volume, academic status, and whether hospitals were a bariatric Center of Excellence. We performed mixed-effects logistic regression adjusting for demographics, insurance coverage, and comorbidities to compare odds of undergoing SG vs RNY, with a random effect for hospital.
5,017 patients were included with 3,042 (60.6%) undergoing SG and 1,975 (39.4%) undergoing RNY. On multivariable analysis, patients with a high DCI were not more likely to undergo a SG (OR 1.18, CI 0.89-1.55, p = 0.25). However, patients who underwent surgery at hospitals serving the greatest proportion of those from highly distressed communities were significantly more likely to undergo SG (OR 4.22, CI 1.38-12.96, p = 0.01). Patients managed at Bariatric Centers of Excellence were less likely to undergo SG (OR 0.22, CI 0.07-0.62, p = 0.005). Patients with higher BMI, diabetes, or GERD were all more likely to undergo RNY.
While patients with high DCI were more likely to undergo SG on univariate analysis, these associations disappeared after addition of a hospital-level random effect, suggesting that disparities may be due access to surgeons or systems with preference for one procedure. However, hospitals serving a higher proportion of high-DCI patients are more likely to utilize SG.
袖状胃切除术（SG）在减肥方面的应用呈指数级增长；然而，SG 与 Roux-en-Y 胃旁路术（RNYGB）相比，其明确的适应证仍缺乏。由于 SG 技术更简单，且没有明确的临床适应证，某些人群可能更倾向于接受 SG。我们旨在研究单一州内接受 SG 与 RNY 的患者的潜在预测因素。
我们在科罗拉多州所有支付者索赔数据库中查询了接受腹腔镜 SG 或 RNY 的患者。患者水平的变量包括患者的人口统计学特征、合并症、手术距离和困扰社区指数（DCI），这是一个基于邮政编码的社会经济地位衡量指标。医院水平的变量包括每年的减重手术量、学术地位以及医院是否为减重卓越中心。我们进行了混合效应逻辑回归分析，以调整人口统计学、保险覆盖范围和合并症，以比较接受 SG 与 RNY 的可能性，医院为随机效应。
共纳入 5017 例患者，其中 3042 例（60.6%）接受 SG，1975 例（39.4%）接受 RNY。多变量分析显示，DCI 较高的患者接受 SG 的可能性没有增加（OR 1.18，CI 0.89-1.55，p=0.25）。然而，在服务于高度困扰社区的人群比例最大的医院接受手术的患者，接受 SG 的可能性显著增加（OR 4.22，CI 1.38-12.96，p=0.01）。在减重卓越中心接受治疗的患者接受 SG 的可能性较低（OR 0.22，CI 0.07-0.62，p=0.005）。BMI 较高、糖尿病或 GERD 的患者更有可能接受 RNY。
虽然 DCI 较高的患者在单因素分析中更有可能接受 SG，但在加入医院水平的随机效应后，这些关联消失了，这表明差异可能是由于获得外科医生或系统的机会不同，或者是因为系统对一种手术有偏好。然而，服务于高 DCI 患者比例较高的医院更有可能使用 SG。
