Acute Care Utilization and Costs Up to 4 Years After Index Sleeve Gastrectomy or Roux-en-Y Gastric Bypass: A National Claims-based Study.
Acute Care Utilization and Costs Up to 4 Years After Index Sleeve Gastrectomy or Roux-en-Y Gastric Bypass: A National Claims-based Study.
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DOI：
10.1097/sla.0000000000004972
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发表时间：
2023-01-01
影响因子：
9
通讯作者：
Lewis KH
中科院分区：
文献类型：
--
作者：
Callaway Kim K;Argetsinger S;Wharam JF;Zhang F;Arterburn DE;Fernandez A;Ross-Degnan D;Wallace J;Lewis KH
比较袖状胃切除术（SG）和Roux-en-Y胃旁路术（RYGB）后的急性护理利用率和成本。比较肥胖后急诊科（艾德）和住院患者的护理使用模式，可以帮助程序的选择，并提供有关并发症风险的见解。我们使用国家保险索赔数据库来识别2008年至2016年期间接受SG和RYGB的成年人。患者在年龄、性别、日历时间、糖尿病和基线急性护理使用方面进行匹配。我们使用调整后的考克斯比例风险来比较急性护理利用率，并使用两部分logistic回归模型来比较SG和RYGB之间的年度相关成本（任何成本的几率和高成本的几率，定义为≥第80百分位数），总体上和几个临床类别内。匹配队列包括4263例SG和4520例RYGB患者。术后4年内，SG患者的艾德访视风险[校正风险比（aHR）：0.90; 95%置信区间（CI）：0.85，0.96]和住院时间略低（aHR：0.80; 95% CI：0.73，0.88），尤其是与消化系统诊断相关的事件（艾德aHR：0.68; 95%CI：0.62，0.75;住院aHR：0.61; 95%CI：0.53，0.72）。SG患者在早期随访中发生高艾德和高急性总费用的几率也较低（例如，第1年急性费用调整的比值比（aOR）为0.77; 95%CI：0.66，0.90）。然而，观察到的成本差异在第3年和第4年下降（例如，第4年急性护理成本aOR 1.10; 95% CI：0.92，1.31）。SG可能有更少的并发症需要紧急护理和住院治疗，特别是与消化系统疾病。然而，SG的任何急性护理成本优势可能会随着时间的推移而减弱。
To compare acute care utilization and costs following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Comparing postbariatric emergency department (ED) and inpatient care use patterns could assist with procedure choice and provide insights about complication risk. We used a national insurance claims database to identify adults undergoing SG and RYGB between 2008 and 2016. Patients were matched on age, sex, calendar-time, diabetes, and baseline acute care use. We used adjusted Cox proportional hazards to compare acute care utilization and 2-part logistic regression models to compare annual associated costs (odds of any cost, and odds of high costs, defined as ≥80th percentile), between SG and RYGB, overall and within several clinical categories. The matched cohort included 4263 SG and 4520 RYGB patients. Up to 4 years after surgery, SG patients had slightly lower risk of ED visits [adjusted hazard ratio (aHR): 0.90; 95% confidence interval (CI): 0.85,0.96] and inpatient stays (aHR: 0.80; 95% CI: 0.73,0.88), especially for events associated with digestive-system diagnoses (ED aHR: 0.68; 95% CI: 0.62,0.75; inpatient aHR: 0.61; 95% CI: 0.53,0.72). SG patients also had lower odds of high ED and high total acute costs (eg, year-1 acute costs adjusted odds ratio (aOR) 0.77; 95% CI: 0.66,0.90) in early follow-up. However, observed cost differences decreased by years 3 and 4 (eg, year-4 acute care costs aOR 1.10; 95% CI: 0.92,1.31). SG may have fewer complications requiring emergency care and hospitalization, especially as related to digestive system disease. However, any acute care cost advantages of SG may wane over time.