Bariatric Surgery's Return on Investment for Veterans and VHA

描述(由申请人提供)： 摘要超过1000万美国成年人，包括16.5万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[身体质量指数(BMI)E40 kg/m2]。这一流行病的影响是巨大的；2000年，III级肥胖症与82,066人死亡和超过110亿美元的美国直接医疗保健支出有关。在过去的十年中，VHA在12个批准的VHA医学中心为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、寿命，并潜在地减少他们的医疗支出。这项拟议的研究建立在我们之前工作的基础上，解决了减肥手术整合到Move之后的几个新的研究问题！程序。首先，我们的研究将解决糖尿病、高血压和高脂血症的消退率。以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证实合并症的解决，以及关注过时的减肥程序。其次，它将跟踪患者整个十年的护理(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，这在文献中一直没有得到很好的描述。第三，我们的研究将寻求确定与失败相关的患者层面的特征--减肥失败、解决合并症失败、以及未能实现长期体重保持--明确地试图确定与不太理想的健康和经济结果相关的重要因素。利用新的临床和实验室数据并进一步扩展我们先前的数据集，这项拟议的研究将建立在我们先前三个主要目标工作的基础上：目标1：比较2000-2010年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之间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解决的持久性。目的2：比较2000-2010年间接受减肥手术的退伍军人和没有接受减肥手术的严重肥胖退伍军人的长期存活率，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年间接受过减肥手术的退伍军人和没有接受过减肥手术的严重肥胖退伍军人之间退伍军人在退伍军人保健利用和退伍军人支出方面的长期趋势。拟议研究的直接目标是扩大我们先前的工作，增加我们的队列规模，并观察他们更长的时间，以便能够检查十年存活率、医疗保健使用和支出，以及体重变化和合并症解决的长期持久性。拟议研究的较长期目标是确定哪些退伍军人是减肥手术的理想对象，哪些退伍军人可能因为手术并发症和死亡率的高风险或因为他们在体重变化和/或疾病解决方面对手术的反应不大而没有得到减肥手术的良好服务。最后，拟议的研究对卫生保健获取/农村健康的高铁和发展优先领域作出了高度响应。

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.