COVID-19 变化对代谢和减重手术后结局及社会经济差异的影响。
Effect of COVID-19 changes on outcomes and socioeconomic disparities following metabolic and bariatric surgery.
机构信息
Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6th Floor, Sacramento, CA, 95817, USA.
Center for Metabolic and Alimentary Science, University of California, Davis, Sacramento, USA.
出版信息
Surg Endosc. 2024 Nov;38(11):6446-6455. doi: 10.1007/s00464-024-11212-z. Epub 2024 Sep 12.
BACKGROUND
We previously showed worse outcomes among lower socioeconomic status (SES) groups following metabolic/bariatric surgery (MBS). In light of healthcare changes in response to COVID-19, this study aims to evaluate post-pandemic MBS outcomes and determine if prior socioeconomic disparities persisted in the post-COVID era.
METHODS
A retrospective chart review of patients undergoing primary Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between 2015 and 2022 was performed. Patients were stratified into pre- and post-COVID groups. Post-COVID cohort was further stratified into high (HT) and low (LT) tier status based on Distressed Communities Index, a geocoded composite measure of SES. Preoperative characteristics and postoperative outcomes were compared between pre- and post-COVID cohorts, as well as between post-COVID HT and LT groups.
RESULTS
Of 709 patients, 82.9% were pre-COVID and 17.1% were post-COVID. Post-COVID cohort had greater rate of public insurance (46% vs. 37%, p < 0.001), longer wait time to surgery (mean 358 ± 609.8 days vs 241.9 ± 368.5 days, p = 0.045), and were more likely to undergo RYGB (69% vs. 56%, p = 0.010). Post-COVID patients also had lower risk of any complications on multivariable analysis (OR 0.599, 95% CI 0.372-0.963), had higher follow-up rates at post-discharge (95.8% vs 79.7%, p < 0.005), 6-month (93% vs. 82%, p < 0.001) and 12-month visits (75% vs. 63%, p = 0.005), and lost more weight at 12 months (67% excess weight loss (%EWL) vs. 58%EWL, p = 0.002). Among post-COVID HT and LT cohorts, previously seen disparities in complications were no longer seen. Finally, there were no differences in weight or follow-up rates between post-COVID HT and LT.
CONCLUSIONS
Post-COVID changes to MBS care have resulted in improved short-term outcomes and reduced disparities for patients of lower SES. Further studies are needed to identify these positive factors to perpetuate practice patterns that optimize care for patients of all socioeconomic status.
背景
我们之前发现社会经济地位（SES）较低的群体在接受代谢/减重手术（MBS）后预后较差。鉴于 COVID-19 疫情下医疗保健的变化，本研究旨在评估大流行后的 MBS 结局，并确定在 COVID-19 后时代，先前的社会经济差异是否仍然存在。
方法
对 2015 年至 2022 年间接受原发性 Roux-en-Y 胃旁路术（RYGB）和袖状胃切除术（SG）的患者进行回顾性图表审查。患者分为 COVID-19 前和 COVID-19 后两组。根据 Distressed Communities Index（一种社会经济地位的地理编码综合衡量标准），将 COVID-19 后队列进一步分为高（HT）和低（LT）层。比较 COVID-19 前和 COVID-19 后两组之间以及 COVID-19 HT 和 LT 组之间的术前特征和术后结局。
结果
在 709 名患者中，82.9%为 COVID-19 前组，17.1%为 COVID-19 后组。COVID-19 后组的公共保险比例更高（46%比 37%，p<0.001），手术等待时间更长（平均 358±609.8 天比 241.9±368.5 天，p=0.045），并且更有可能接受 RYGB（69%比 56%，p=0.010）。多变量分析显示，COVID-19 后患者的任何并发症风险均较低（OR 0.599，95%CI 0.372-0.963），出院后随访率更高（95.8%比 79.7%，p<0.005），6 个月（93%比 82%，p<0.001）和 12 个月（75%比 63%，p=0.005），12 个月时体重减轻更多（67%体重减轻率（%EWL）比 58%EWL，p=0.002）。在 COVID-19 HT 和 LT 队列中，先前观察到的并发症差异不再存在。最后，COVID-19 HT 和 LT 队列之间的体重或随访率没有差异。
结论
MBS 护理方面的 COVID-19 后变化导致 SES 较低的患者短期预后改善和差异缩小。需要进一步研究以确定这些积极因素，以延续优化所有社会经济地位患者护理的实践模式。
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