Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Brest, France; Univ Brest, CHU Brest, UMR 1304, Western Brittany Thrombosis Group, Brest, France.
Qualees, Paris, France.
Surgery. 2024 Nov;176(5):1337-1344. doi: 10.1016/j.surg.2024.07.048. Epub 2024 Aug 28.
BACKGROUND: This study assesses the effectiveness of 5 main conversional or revisional metabolic bariatric surgery sequences after sleeve gastrectomy, adjustable gastric banding and gastric bypass on reimbursement and cost of continuous positive airway pressure therapy, the first line treatment for obstructive sleep apnea, in France. METHODS: This nationwide observational population-based cohort study analyzed data from the French National Health Insurance database. It included all patients who had undergone primary metabolic bariatric surgery in France between January 1, 2012, and December 31, 2014, and followed until December 31, 2020. The study assessed continuous positive airway pressure therapy reimbursement discontinuation and costs of reimbursed continuous positive airway pressure therapy across 5 different conversional or revisional metabolic bariatric surgery sequences. RESULTS: During follow-up, 6,396 patients underwent the following sequences: sleeve gastrectomy-gastric bypass (n = 2,400), adjustable gastric banding-sleeve gastrectomy (n = 2,277), adjustable gastric banding-gastric bypass (n = 1,173), sleeve gastrectomy-sleeve gastrectomy (n = 546), and gastric bypass-others (n =332), with a rate of obstructive sleep apnea of 15.2%, 12.4%, 15.5% 12.8%, and 9.9% in the year before conversional or revisional metabolic bariatric surgery. The rates of patients who had a discontinuation of continuous positive airway pressure were at 2 and 4 years: 41.1%, 41.9%, 46.4%, 29.3%, and 33.3%; 62.3%, 57.0%, 78.2%; 57.5%, and 44.4%, respectively. At 4 years, the mean annual costs (euros) of obstructive sleep apnea treatment per patient were significantly lower (P < .01) than the costs in the year before conversional or revisional metabolic bariatric surgery for each sequence: 526.9 ± 414.4 vs 257.4 ± 349.7; 368.0 ± 247.5 vs 230.9 ± 288.4; 433.7 ± 326.0 vs 116.8 ± 238.3; 540.7 ± 275.3 vs 248.0 ± 308.4 and 501.2 ± 254.0 vs 281.1 ± 287.0, respectively. CONCLUSIONS: Our study underscore the effectiveness of conversional or revisional metabolic bariatric surgery in significantly reducing the need and associated costs of continuous positive airway pressure therapy for patients with obstructive sleep apnea postprimary metabolic bariatric surgery over a 4-year period.
背景：本研究评估了袖状胃切除术、可调胃束带和胃旁路术后 5 种主要的转化或修正代谢减重手术序列对法国持续气道正压通气治疗（阻塞性睡眠呼吸暂停的一线治疗）的报销和成本的影响。
方法：这项全国性的基于人群的观察性队列研究分析了法国国家健康保险数据库中的数据。它包括了 2012 年 1 月 1 日至 2014 年 12 月 31 日期间在法国接受原发性代谢减重手术的所有患者，并随访至 2020 年 12 月 31 日。该研究评估了 5 种不同的转化或修正代谢减重手术序列对持续气道正压通气治疗的报销和已报销的持续气道正压通气治疗的成本的影响。
结果：在随访期间，6396 名患者接受了以下序列：袖状胃切除术-胃旁路术（n=2400）、可调胃束带-袖状胃切除术（n=2277）、可调胃束带-胃旁路术（n=1173）、袖状胃切除术-袖状胃切除术（n=546）和胃旁路术-其他术式（n=332），在转化或修正代谢减重手术前一年，阻塞性睡眠呼吸暂停的发生率分别为 15.2%、12.4%、15.5%、12.8%和 9.9%。在 2 年和 4 年时，停止使用持续气道正压通气的患者比例分别为：41.1%、41.9%、46.4%、29.3%和 33.3%；62.3%、57.0%、78.2%；57.5%和 44.4%。在 4 年时，每个序列的每位患者的阻塞性睡眠呼吸暂停治疗的年平均成本（欧元）显著低于转化或修正代谢减重手术前一年的成本：526.9±414.4 比 257.4±349.7；368.0±247.5 比 230.9±288.4；433.7±326.0 比 116.8±238.3；540.7±275.3 比 248.0±308.4；501.2±254.0 比 281.1±287.0。
结论：我们的研究强调了转化或修正代谢减重手术在原发性代谢减重手术后 4 年内显著减少阻塞性睡眠呼吸暂停患者对持续气道正压通气治疗的需求和相关成本的有效性。
Surg Obes Relat Dis. 2017-3-23
Zotero 插件