Zhang Xinmeng, Kang Kaidi, Yan Chao, Feng Yubo, Vandekar Simon, Yu Danxia, Rosenbloom S Trent, Samuels Jason, Srivastava Gitanjali, Williams Brandon, Albaugh Vance L, English Wayne J, Flynn Charles R, Chen You
Department of Computer Science, Vanderbilt University, Nashville, TN.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
medRxiv. 2024 Jan 21:2024.01.20.24301550. doi: 10.1101/2024.01.20.24301550.
Bariatric surgery is an effective intervention for obesity, but it requires comprehensive postoperative self-management to achieve optimal outcomes. While patient portals are generally seen as beneficial in engaging patients in health management, the link between their use and post-bariatric surgery weight loss remains unclear.
This study investigated the association between patient portal engagement and postoperative body mass index (BMI) reduction among bariatric surgery patients.
This retrospective longitudinal study included patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at Vanderbilt University Medical Center (VUMC) between January 2018 and March 2021. Using generalized estimating equations, we estimated the association between active days of postoperative patient portal use and the reduction of BMI percentage (%BMI) at 3, 6, and 12 months post-surgery. Covariates included duration since surgery, the patient's age at the time of surgery, gender, race and ethnicity, type of bariatric surgery, severity of comorbid conditions, and socioeconomic disadvantage.
The study included 1,415 patients, mostly female (80.9%), with diverse racial and ethnic backgrounds. 805 (56.9%) patients underwent RYGB and 610 (43.1%) underwent SG. By one-year post-surgery, the mean (SD) %BMI reduction was 31.1% (8.3%), and the mean (SD) number of patient portal active days was 61.0 (41.2). A significantly positive association was observed between patient portal engagement and %BMI reduction, with variations revealed over time. Each 10-day increment of active portal use was associated with a 0.57% ([95% CI: 0.42- 0.72], < .001) and 0.35% ([95% CI: 0.22- 0.49], < .001) %BMI reduction at 3 and 6 months postoperatively. The association was not statistically significant at 12 months postoperatively (β=-0.07, [95% CI: -0.24- 0.09], = .54). Various portal functions, including messaging, visits, my record, medical tools, billing, resources, and others, were positively associated with %BMI reduction at 3- and 6-months follow-ups.
Greater patient portal engagement, which may represent stronger adherence to postoperative instructions, better self-management of health, and enhanced communication with care teams, was associated with improved postoperative weight loss. Future investigations are needed to identify important portal features that contribute to the long-term success of weight loss management.
减肥手术是治疗肥胖症的有效干预措施，但术后需要全面的自我管理才能取得最佳效果。虽然患者门户网站通常被认为有助于患者参与健康管理，但其使用与减肥手术后体重减轻之间的联系仍不明确。
本研究调查了减肥手术患者使用患者门户网站与术后体重指数（BMI）降低之间的关联。
这项回顾性纵向研究纳入了2018年1月至2021年3月在范德比尔特大学医学中心（VUMC）接受 Roux-en-Y胃旁路术（RYGB）或袖状胃切除术（SG）的患者。我们使用广义估计方程，估计术后患者使用门户网站的活跃天数与术后3个月、6个月和12个月时BMI降低百分比（%BMI）之间的关联。协变量包括手术时间、手术时患者年龄、性别、种族和民族、减肥手术类型、合并症严重程度以及社会经济劣势。
该研究纳入了1415名患者，大多数为女性（80.9%），具有不同的种族和民族背景。805名（56.9%）患者接受了RYGB，610名（43.1%）患者接受了SG。术后一年，平均（标准差）%BMI降低为31.1%（8.3%），患者门户网站活跃天数的平均（标准差）为61.0（41.2）天。观察到患者参与门户网站与%BMI降低之间存在显著的正相关，且随时间有所变化。术后3个月和6个月时，门户网站活跃使用天数每增加10天，与%BMI降低0.57%（[95%置信区间：0.42 - 0.72]，P <.001）和0.35%（[95%置信区间：0.22 - 0.49]，P <.001）相关。术后12个月时，该关联无统计学意义（β = -0.07，[95%置信区间：-0.24 - 0.09]，P =.54）。在3个月和6个月的随访中，各种门户网站功能，包括消息传递、访问、我的记录、医疗工具、计费、资源等，均与%BMI降低呈正相关。
更多地参与患者门户网站，这可能代表着更强地遵守术后指导、更好地自我健康管理以及与护理团队加强沟通，与术后体重减轻改善相关。未来需要进行调查，以确定有助于减肥管理长期成功的重要门户网站特征。
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