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

综合护理系统中减肥手术的长期益处和风险

基本信息

批准号：
8940898
负责人：
David Eric Arterburn
金额：
$ 75.6万
依托单位：
KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-15 至 2019-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8940898
关键词：
Address Adult Adverse event Age Bariatrics Benefits and Risks Body Weight Body Weight decreased Caring Cessation of life Characteristics Chronic Kidney Failure Clinical Clinical Practice Guideline Code Cohort Studies Comorbidity Complication Computerized Medical Record Data Data Collection Databases Decision Making Disease remission Electronics Epidemic Ethnic Origin Event Future Gender Goals Growth Health Health Maintenance Organizations Health Planning Healthcare Healthcare Systems Hypertension ICD-9 Incidence Integrated Health Care Systems Investments Kidney Diseases Knowledge Long-Term Effects Malignant Neoplasms Manuals Measurement Medical Mental Health Methods Minority Groups Morbid Obesity National Institute of Diabetes and Digestive and Kidney Diseases Non-Insulin-Dependent Diabetes Mellitus Obesity Operative Surgical Procedures Outcome Outcome Measure Pathway interactions Patients Persons Physicians Population Postoperative Period Procedures Publishing Race Randomized Controlled Trials Registries Repeat Surgery Reporting Research Research Infrastructure Safety Severities Specificity Statistical Models System Techniques Time United States Weight adverse outcome bariatric surgery base care systems cohort comparative effectiveness comparison group effective intervention experience follow-up health care delivery hypertension control improved member novel population based prospective public health relevance response safety study trial comparing

项目摘要

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.

描述（由适用提供）：严重肥胖的流行病持续不断，3600万美国成年人（14.5％）目前的BMI = 35 kg/m2。在过去的20年中，减肥手术已成为诱导体重减轻和合并症改善的最有效干预措施。但是，关于减肥手术的长期结局的证据仍然是一个关键的差距。拟议的项目将是迄今为止最大的研究研究减肥手术与体重，高血压和肾脏疾病的持久改善之间的长期关系，以及与重大工作并发症和长期生存的关联。我们还将将这些结果与尚未进行体重减轻手术的严重肥胖患者的同类群体进行比较，这些患者尚未进行减肥手术，并研究人口统计学和临床特征（例如，年龄，性别，种族/种族/种族，减肥手术类型，T2DM严重程度以及其他合并症的医疗和心理健康状况及其治疗方法）可能与有益的外表现相关联。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45,000名严重肥胖的患者进行回顾性队列研究，这些患者在17年（1997-2013）中在三个大型综合医疗保健系统中接受了减肥手术。世界上大多数潜水员的减肥人口，有41％的种族/族裔少数民族患者。减肥程序和长期结果将使用以前由我们团队成员发表或验证的方法从现有的电子病历和注册表数据库中识别出来。我们将使用基于高级倾向的统计方法来仔细识别具有严重肥胖症的非手术比较组。我们将使用主要数据收集和图表审查的组合研究数据库中偏差的潜力。这些新颖的数据将使我们能够确定结果指标的有效性，并确定遗漏数据库中数据库中的受试者是否具有与拥有完整数据的受试者的长期结果不同。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益处，并有助于指导减肥患者的手术前和手术后护理途径的改善。我们的发现还将有助于改善医疗系统在减肥手术中的投资回报率。