Department of Surgery, Central Clinical School, Alfred Health, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia.
Oesophago-Gastric and Bariatric Unit, Alfred Health, Melbourne, Victoria, 3004, Australia.
Obes Surg. 2023 Apr;33(4):1160-1169. doi: 10.1007/s11695-023-06489-3. Epub 2023 Feb 16.
This study aims to determine if the hospital efficiency, safety and health outcomes are equal in patients who receive bariatric surgery in government-funded hospitals (GFH) versus privately funded hospitals (PFH).
This is a retrospective observational study of prospectively maintained data from the Australia and New Zealand Bariatric Surgery Registry of 14,862 procedures (2134 GFH and 12,728 PFH) from 33 hospitals (8 GFH and 25 PFH) performed in Victoria, Australia, between January 1st, 2015, and December 31st, 2020. Outcome measures included the difference in efficacy (weight loss, diabetes remission), safety (defined adverse event and complications) and efficiency (hospital length of stay) between the two health systems.
GFH treated a higher risk patient group who were older by a mean (SD) 2.4 years (0.27), P < 0.001; had a mean 9.0 kg (0.6) greater weight at time of surgery, P < 0.001; and a higher prevalence of diabetes at day of surgery OR = 2.57 (CI2.29-2.89), P < 0.001. Despite these baseline differences, both GFH and PFH yielded near identical remission of diabetes which was stable up to 4 years post-operatively (57%). There was no statistically significant difference in defined adverse events between the GFH and PFH (OR = 1.24 (CI 0.93-1.67), P = 0.14). Both healthcare settings demonstrated that similar covariates affect length of stay (LOS) (diabetes, conversion bariatric procedures and defined adverse event); however, these covariates had a greater effect on LOS in GFH compared to PFH.
Bariatric surgery performed in GFH and PFH yields comparable health outcomes (metabolic and weight loss) and safety. There was a small but statistically significant increased LOS following bariatric surgery in GFH.
本研究旨在确定在接受减重手术的患者中，政府资助医院（GFH）与私人资助医院（PFH）的医院效率、安全性和健康结果是否相等。
这是一项回顾性观察研究，对 2015 年 1 月 1 日至 2020 年 12 月 31 日期间在澳大利亚维多利亚州的 33 家医院（8 家 GFH 和 25 家 PFH）进行的 14862 例手术（2134 例 GFH 和 12728 例 PFH）前瞻性维护数据进行的回顾性观察研究。结果包括两种医疗体系之间疗效（体重减轻、糖尿病缓解）、安全性（定义不良事件和并发症）和效率（住院时间）的差异。
GFH 治疗的患者年龄较大，平均（SD）大 2.4 岁（0.27），P<0.001；手术时体重平均增加 9.0 公斤（0.6），P<0.001；且术前糖尿病患病率较高 OR=2.57（95%CI2.29-2.89），P<0.001。尽管存在这些基线差异，但 GFH 和 PFH 均使糖尿病缓解率几乎相同，术后 4 年内稳定（57%）。GFH 和 PFH 之间定义不良事件无统计学显著差异（OR=1.24（95%CI0.93-1.67），P=0.14）。两种医疗环境均表明，相似的协变量影响住院时间（LOS）（糖尿病、转化减肥手术和定义不良事件）；然而，这些协变量对 GFH 中 LOS 的影响大于 PFH。
GFH 和 PFH 进行的减肥手术可产生相似的健康结果（代谢和体重减轻）和安全性。GFH 减肥手术后 LOS 略有但统计学上显著增加。
