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

• 批准号: 9329410
• 负责人: David Eric Arterburn
• 金额: $ 64.41万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-15 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9329410
• 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; Comorbidity; Complication; Computerized Medical Record; Data; Data Collection; Databases; Decision Making; Disease remission; 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; 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; Retrospective cohort study; Risk; 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; ethnic minority population; experience; follow-up; health care delivery; hypertension control; improved; member; novel; outcome prediction; population based; prospective; public health relevance; racial and ethnic; response; safety study; trial comparing

 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（由申请人提供）：严重肥胖的流行性增长持续不减，目前有3600万美国成年人（14.5%）的BMI =35 kg/m2。在过去的20年里，减肥手术已经成为最有效的干预措施，以诱导体重减轻和改善合并症。然而，减肥手术的长期结果的证据仍然是一个关键的差距。拟议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、高血压和肾脏疾病的持久改善之间的长期关系，以及与主要手术并发症和长期生存率的关系。我们还将这些结果与未进行减肥手术的严重肥胖患者的基于人群的队列进行比较，并调查人口统计学和临床特征（例如，年龄、性别、人种/种族、减肥手术类型、T2 DM严重程度和其他共病医学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17年（1997-2013）期间在三个大型综合医疗保健系统接受减肥手术的45，000多名严重肥胖患者进行回顾性队列研究。这是世界上最大和最多样化的肥胖人群，其中41%为少数民族患者。减肥手术和长期结果将从现有的电子病历和注册数据库中确定，使用的方法之前已发表或由我们的团队成员验证。我们将使用先进的基于倾向的统计方法来仔细识别患有严重肥胖症的非手术对照组。我们将通过结合原始数据收集和图表审查来调查我们数据库中偏倚的可能性。这些新数据将使我们能够确定我们的结局指标的有效性，并确定我们的数据库中缺失数据的受试者是否具有与完整数据的受试者不同的长期结局。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，并将有助于指导减肥患者术前和术后护理途径的改进。我们的研究结果还将有助于提高医疗保健系统在减肥手术中的投资回报。