Bariatric Surgery's Return on Investment for Veterans and VHA

描述（由申请人提供）： 超过1000万美国成年人，包括165,000名使用退伍军人事务部（VA）医疗设施的退伍军人，患有III级肥胖[体重指数（BMI）e40 kg/m2]。这种流行病的影响是巨大的;在2000年，III类肥胖症与82，066例死亡和超过110亿美元的直接美国卫生保健支出有关。在过去的十年中，VHA在12个批准的VHA医疗中心为1000多名严重肥胖的退伍军人提供减肥手术，希望改善他们的体重，健康，长寿，并可能减少他们的医疗保健支出。拟议的研究建立在我们以前的工作，通过解决几个新的研究问题后，减肥手术被整合到移动！程序. 首先，我们的研究将解决糖尿病，高血压和高脂血症的解决率。之前对这个问题的研究有很多局限性，包括缺乏非手术对照组，缺乏实验室和血压数据来确认合并症的解决，以及关注过时的减肥手术。其次，它将跟踪患者整整十年的护理（2000-2010），以确定这些健康改善的长期持久性，包括减肥的持久性，这在文献中描述得很差。第三，我们的研究将寻求确定与失败相关的患者水平特征-减肥失败，未能解决合并症，未能实现长期体重维持-明确尝试确定与不理想的健康和经济结果相关的重要因素。 使用新的临床和实验室数据，并将我们先前的数据集扩展到更远的时间，拟议的研究将建立在我们先前的工作的三个主要目标：目标1：比较2000-2010年期间接受减肥手术的退伍军人和未接受减肥手术的严重肥胖退伍军人的体重变化和糖尿病、高血压和高脂血症的解决情况，并检查手术病例中体重变化和疾病消退的持久性。目标二：比较2000-2010年接受减肥手术的退伍军人和未接受减肥手术的严重肥胖退伍军人的长期生存率，并检查手术病例中主要手术并发症的趋势。目标3：比较2000- 2010年接受减肥手术的退伍军人和未接受减肥手术的严重肥胖退伍军人之间VA医疗保健利用和VA支出的长期趋势。 拟议研究的直接目标是通过增加队列规模并观察更长时间来扩展我们先前的工作，以检查10年生存率，医疗保健使用和支出以及体重变化的长期持久性和合并症的解决。拟议研究的长期目标是确定适合进行减肥手术的退伍军人，以及因手术并发症和死亡率风险高或因体重变化和/或疾病消退对手术反应温和而可能无法接受减肥手术的退伍军人。最后，拟议的研究是高度响应HSR&D优先领域的卫生保健服务/农村健康。

DESCRIPTION (provided by applicant): Abstract More than 10 million U.S. adults, including 165,000 veterans who use Veterans Affairs (VA) medical facilities, have class III obesity [body mass index (BMI)e40 kg/m 2]. The impact of this epidemic is substantial; in 2000, class III obesity was associated with 82,066 deaths and over $11 billion in direct U.S. health care expenditures. Over the past decade, VHA has provided bariatric surgery to over 1000 severely obese veterans in 12 approved VHA Medical Centers in the hopes of improving their body weight, health, longevity, and potentially also reducing their health care expenditures. The proposed study builds on our prior work by addressing several novel research questions after bariatric surgery was integrated into the MOVE! program. First, our study will address the rate of resolution of diabetes, hypertension, and hyperlipidemia. Prior studies of this question have had many limitations, including a lack of a non-surgical control group, a lack of laboratory and blood pressure data to confirm resolution of comorbidities, and a focus on out-dated bariatric procedures. Second, it will follow patients over an entire decade of care (2000-2010) to establish the long-term durability of these health improvements, including the durability of weight loss, which has been poorly characterized in the literature. Third, our study will seek to identify patient-level characteristics that are associated with failures - failures to lose weight, failures to resolve comorbidities, and failures to achieve long- term weight maintenance - in an explicit attempt to identify important factors associated with less desirable health and economic outcomes. Using new clinical and laboratory data and expanding our prior datasets farther in time, the proposed study will build on our prior work in three primary aims: Aim 1: Compare weight change and resolution of diabetes, hypertension, and hyperlipidemia between veterans who had bariatric surgery and a matched cohort of severely obese veterans who did not have bariatric surgery in 2000-2010, and examine the durability of weight change and disease resolution among surgical cases. Aim 2: Compare long-term survival between veterans who had bariatric surgery and a matched cohort of severely obese veterans who did not have bariatric surgery in 2000-2010, and examine trends in major surgical complications among surgical cases. Aim 3: Compare long-term trends in VA health care utilization and VA expenditures between veterans who had bariatric surgery and a matched cohort of severely obese veterans who did not have bariatric surgery in 2000- 2010. The immediate objective of the proposed study is to expand our prior work by increasing our cohort size and observing them for a greater duration of time to allow examinations of ten-year survival, health care use, and expenditures and the long-term durability of changes in weight and resolution of comorbidities. The longer- term objective of the proposed study is to identify veterans who are ideal candidates for bariatric surgery and veterans who may not be well served by bariatric surgery because of their high risk for surgical complications and mortality or because of their modest response to surgery in terms of weight change and/or disease resolution. Finally, the proposed study is highly responsive to the HSR&D Priority Area of Health Care Access/Rural Health.