连续脉搏血氧仪管理减肥手术中未确诊的阻塞性睡眠呼吸暂停的成本效益和安全性：一项全国性队列研究

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases Pub Date : 2024-12-01 DOI:10.1016/j.soard.2024.06.009

Sophie L. van Veldhuisen M.D., Ph.D. , Willem R. Keusters M.Sc. , Kim Kuppens M.D. , Christel A.L. de Raaff M.D., Ph.D. , Ruben N. van Veen M.D., Ph.D. , Marinus J. Wiezer M.D., Ph.D. , Dingeman J. Swank M.D., Ph.D. , Ahmet Demirkiran M.D., Ph.D. , Evert-Jan G. Boerma M.D., Ph.D. , Jan-Willem M. Greve M.D., Ph.D. , Francois M.H. van Dielen M.D., Ph.D. , Steve M.M. de Castro M.D., Ph.D. , Geert W.J. Frederix Ph.D. , Eric J. Hazebroek M.D., Ph.D.

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引用次数: 0

摘要

背景：未检测到的阻塞性睡眠呼吸暂停（OSA）在接受减肥手术的患者中非常普遍，并增加围手术期风险。术前测谎（PG）和持续气道正压通气（CPAP）筛查OSA既昂贵又耗时。术后连续脉搏血氧仪（CPOX）侵入性较小，被认为是一种安全且经济有效的替代方法。目的：这项全国范围内的多中心前瞻性观察队列研究比较了CPOX监测与使用pg设置的osa筛查。方法患者在术前未进行OSA筛查的情况下进行CPOX术后监测，或在诊断为OSA时进行术前PG和CPAP治疗。队列安置是基于当地医院的协议。使用质量调整生命年（QALYs）和医疗保健成本分析成本效益。同时对手术结果进行分析。敏感性分析采用倾向评分匹配。结果共纳入1390例患者。各组在基线和术后1年的质量aly相似。术后并发症，重症监护病房（ICU）入院和入院，特别是与osa相关的入院，在两组之间没有差异。CPOX组每位患者/年的平均费用为3094欧元，PG组为3680欧元；平均差异€- 586 （95% CI€- 933 -€- 242）。根据倾向评分匹配，1390名纳入的患者中有1090名被保留，并且在成本效益、并发症和ICU入院方面观察到类似的结果。结论与PG相比，术前不进行osa筛查的CPOX监测与更高的并发症或再入院率无关。从医疗保健角度来看，CPOX的成本更低，因此可以被认为是接受减肥手术的患者常规osa筛查的一种具有成本效益的替代方案。

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Cost-effectiveness and safety of continuous pulse oximetry for management of undiagnosed obstructive sleep apnea in bariatric surgery: a nationwide cohort study

Background

Undetected obstructive sleep apnea (OSA) is highly prevalent in patients undergoing bariatric surgery and increases perioperative risks. Screening for OSA using preoperative polygraphy (PG) with subsequent continuous positive airway pressure (CPAP) is costly and time-consuming. Postoperative continuous pulse oximetry (CPOX) is less invasive, and is hypothesized to be a safe and cost-effective alternative.

Objectives

This nationwide multicenter prospective observational cohort study compared CPOX monitoring with OSA-screening using PG.

Setting

High-volume bariatric centers.

Methods

Patients were either postoperatively monitored using CPOX without preoperative OSA-screening, or underwent preoperative PG and CPAP treatment when OSA was diagnosed. Cohort placement was based on local hospital protocols. Cost-effectiveness was analyzed using quality adjusted life years (QALYs) and healthcare costs. Surgical outcomes were also analyzed. Propensity score matching was used in sensitivity analyses.

Results

A total of 1390 patients were included. QALYs were similar between groups at baseline and 1-year postoperatively. Postoperative complications, intensive care unit (ICU)-admissions and admissions, particularly OSA-related, did not differ between groups. Mean costs per patient/year in the CPOX group was €3094 versus €3680 in the PG group; mean difference €−586 (95% CI €−933–€−242). Following propensity score matching, 1090 of 1390 included patients remained, and similar findings for cost-effectiveness, complications, and ICU admissions were observed.

Conclusion

CPOX monitoring without preoperative OSA-screening was not associated with higher complication or readmission rates compared to PG. CPOX resulted in lower costs from a healthcare perspective and can therefore be considered a cost-effective alternative to routine OSA-screening in patients undergoing bariatric surgery.

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来源期刊

Surgery for Obesity and Related Diseases 医学-外科

CiteScore

6.70

自引率

12.90%

发文量

570

审稿时长

56 days

期刊介绍： Surgery for Obesity and Related Diseases (SOARD), The Official Journal of the American Society for Metabolic and Bariatric Surgery (ASMBS) and the Brazilian Society for Bariatric Surgery, is an international journal devoted to the publication of peer-reviewed manuscripts of the highest quality with objective data regarding techniques for the treatment of severe obesity. Articles document the effects of surgically induced weight loss on obesity physiological, psychiatric and social co-morbidities.