减肥手术患者出行:距离重要吗?

J Hunter Mehaffey, Alex D Michaels, Mathew G Mullen, Max O Meneveau, John R Pender, Peter T Hallowell
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引用次数: 0

摘要

背景:越来越多的患者在大容量中心接受减肥手术时面临更大的旅行距离。目的:本研究旨在评估出行距离对减肥手术后获得护理和结果的影响。背景:1985 - 2004年在某学术减肥手术中心接受Roux-en-Y胃旁路手术的患者,根据患者的行走距离进行检查和分层。方法:对术前危险因素、30天并发症和“当地”(定义为1小时旅行时间)之间的长期(10年)体重减轻进行单因素分析。采用Kaplan-Meier和Cox比例风险模型进行生存分析。结果:650例患者行Roux-en-Y胃旁路术,其中316例(48.6%)行1小时。组间中位体重指数相当(局部,52.9 kg/m2;区域:53.2 kg/m2;P = .76)。旅行距离越远的患者术前共病的发生率越高,包括慢性阻塞性肺疾病、充血性心力衰竭、糖尿病和睡眠呼吸暂停(均为p)。结论:大多数在我们中心接受减肥手术的患者旅行时间为100小时。尽管就医的旅行时间更长,但30天的并发症和长期体重下降与当地患者相当。正如预期的那样,住得近的患者更有可能坚持每年在外科诊所随访。旅行时间是风险调整后长期生存率降低的独立预测因子。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Patient travel for bariatric surgery: does distance matter?

Background: Increasingly, patients are faced with greater travel distances to undergo bariatric surgery at high-volume centers.

Objectives: This study sought to evaluate the impact of travel distance on access to care and outcomes after bariatric surgery.

Setting: Patients who underwent Roux-en-Y gastric bypass at an academic bariatric surgery center from 1985 to 2004 were examined and stratified by patient travel distance.

Methods: Univariate analyses were performed for preoperative risk factors, 30-day complications, and long-term (10-yr) weight loss between "local," defined as<1 hour of travel time, and "regional," defined as>1 hour of travel time. Survival analysis was performed with Kaplan-Meier and Cox proportional hazards models.

Results: A total of 650 patients underwent Roux-en-Y gastric bypass, of whom 316 (48.6%) traveled<1 hour to undergo surgery and 334 (51.4%) traveled>1 hour. Median body mass index was equivalent between the groups (local, 52.9 kg/m2; regional, 53.2 kg/m2; P = .76). Patients who traveled longer distances had higher rates of preoperative co-morbidities, including chronic obstructive pulmonary disease, congestive heart failure, diabetes, and sleep apnea (all P<.05). Complications within 30 days of surgery and long-term reduction of excess body mass index were equivalent between groups. Travel time was an independent predictor of risk-adjusted reduced long-term survival (hazard ratio, 1.23, P = .0002).

Conclusions: A majority of patients who underwent bariatric surgery at our center traveled>1 hour. Despite longer travel time for care, 30-day complications and long-term weight loss were equivalent with that of local patients. As expected, patients who lived in close proximity were more likely to adhere to yearly follow-up in surgery clinic. Travel time was an independent predictor of risk-adjusted reduced long-term survival.

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