Long-term Benefits and Risks of Bariatric Surgery in Integrated Care Systems

 描述(申请人提供)：严重肥胖症的流行增长有增无减，目前有3600万美国成年人(14.5%)的BMI=35公斤/平方米。在过去的20年里，减肥手术已经成为促进减肥和改善并发症的最有效的干预措施。然而，关于减肥手术的长期结果的证据仍然存在严重差距。拟议中的项目将是迄今为止规模最大的研究 研究减肥手术与体重、高血压和肾脏疾病持续改善之间的长期关系，以及与主要手术并发症和长期存活率的关系。我们还将把这些结果与没有接受过减肥手术的严重肥胖患者的人群队列进行比较，并调查可能与手术有利和不利结果相关的人口学和临床特征(例如，年龄、性别、种族/民族、减肥手术类型、T2 DM严重程度以及其他共病的医疗和心理健康状况及其治疗)。在我们先前研究中成功应用的方法的基础上，我们将对超过4.5万名严重肥胖患者进行回顾性队列研究，这些患者在17年内(1997-2013)在三个大型综合医疗保健系统接受减肥手术。这是世界上最大和最多样化的减肥人群，有41%的种族/少数民族患者。减肥程序和长期结果将使用我们团队成员先前发布或验证的方法，从现有的电子医疗记录和注册数据库中确定。我们将使用先进的基于倾向性的统计方法仔细识别严重肥胖症的非手术对照组。我们将结合原始数据收集和图表审查来调查我们的数据库中可能存在的偏差。这些新数据将使我们能够确定我们结果衡量标准的有效性，并确定在我们的数据库中缺少数据的受试者与那些拥有完整数据的受试者是否具有不同的长期结果。从这项研究中获得的信息将使医生和患者能够更准确地评估减肥手术干预的长期风险和好处，并将有助于指导改善减肥患者的术前和术后护理路径。我们的发现还将有助于提高医疗保健系统在减肥手术方面的投资回报。

 DESCRIPTION (provided by applicant): The epidemic growth of severe obesity continues unabated, and 36 million U.S. adults (14.5%) currently have a BMI =35 kg/m2. In the last 20 years, bariatric procedures have emerged as the most effective interventions to induce weight loss and improvements in comorbidities. However, evidence about the long-term outcomes of bariatric surgery remains a critical gap. The proposed project will be the largest study to date to investigate the long-term relationships between bariatric surgery and durable improvements in body weight, hypertension, and renal disease, as well as its association with major operative complications and long-term survival. We will also compare these outcomes to a population-based cohort of severely obese patients who have not had weight loss surgery and investigate demographic and clinical characteristics (e.g., age, gender, race/ethnicity, bariatric procedure type, T2DM severity, and other comorbid medical and mental health conditions and their treatments) that may be associated with beneficial and adverse outcomes of surgery. Building upon methods that have been successfully applied in our prior studies, we will conduct a retrospective cohort study of more than 45,000 severely obese patients who underwent bariatric surgery in three large integrated health care systems over a 17-year period (1997-2013). This is the largest and most diverse bariatric population in the world with 41% racial/ethnic minority patients. Bariatric procedures and long-term outcomes will be identified from existing electronic medical record and registry databases using approaches that have been previously published or validated by members of our team. We will use advanced propensity- based statistical approaches to carefully identify a non-surgical comparison group with severe obesity. And we will investigate the potential for biases in our databases using a combination of primary data collection and chart review. These novel data will allow us to establish the validity of our outcome measures and establish whether subjects who have missing data in our databases have different long-term outcomes than those with complete data. The information gained from this study will enable physicians and patients to more accurately assess the long- term risks and benefits of bariatric surgical intervention and will help guide improvements in pre- and post- operative care pathways for bariatric patients. Our findings will also help improve the return on investment that healthcare systems are making in weight loss surgery.