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Turri JAO, Anokye NK, Dos Santos LL, Júnior JMS, Baracat EC, Santo MA, Sarti FM. Impacts of bariatric surgery in health outcomes and health care costs in Brazil: Interrupted time series analysis of multi-panel data. BMC Health Serv Res 2022; 22:41. [PMID: 34996426 PMCID: PMC8740498 DOI: 10.1186/s12913-021-07432-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background The increasing burden of obesity generates significant socioeconomic impacts for individuals, populations, and national health systems worldwide. The literature on impacts and cost-effectiveness of obesity-related interventions for prevention and treatment of moderate to severe obesity indicate that bariatric surgery presents high costs associated with high effectiveness in improving health status referring to certain outcomes; however, there is a lack of robust evidence at an individual-level estimation of its impacts on multiple health outcomes related to obesity comorbidities. Methods The study encompasses a single-centre retrospective longitudinal analysis of patient-level data using micro-costing technique to estimate direct health care costs with cost-effectiveness for multiple health outcomes pre-and post-bariatric surgery. Data from 114 patients who had bariatric surgery at the Hospital of Clinics of the University of Sao Paulo during 2018 were investigated through interrupted time-series analysis with generalised estimating equations and marginal effects, including information on patients' characteristics, lifestyle, anthropometric measures, hemodynamic measures, biochemical exams, and utilisation of health care resources during screening (180 days before) and follow-up (180 days after) of bariatric surgery. Results The preliminary statistical analysis showed that health outcomes presented improvement, except cholesterol and VLDL, and overall direct health care costs increased after the intervention. However, interrupted time series analysis showed that the rise in health care costs is attributable to the high cost of bariatric surgery, followed by a statistically significant decrease in post-intervention health care costs. Changes in health outcomes were also statistically significant in general, except in cholesterol and LDL, leading to significant improvements in patients' health status after the intervention. Conclusions Trends multiple health outcomes showed statistically significant improvements in patients' health status post-intervention compared to trends pre-intervention, resulting in reduced direct health care costs and the burden of obesity.
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Affiliation(s)
- José Antonio Orellana Turri
- Department of Gynecology and Obstetrics, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil. .,School of Public Health, University of Sao Paulo, Av Dr Arnaldo 715, Sao Paulo, SP, Brazil.
| | - Nana Kwame Anokye
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, United Kingdom
| | - Lionai Lima Dos Santos
- Department of Physiotherapy, School of Sciences and Technology, Sao Paulo State University, Rua Roberto Simonsen, Presidente Prudente, SP, 305, Brazil
| | - José Maria Soares Júnior
- Department of Gynecology and Obstetrics, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Department of Gynecology and Obstetrics, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil
| | - Marco Aurélio Santo
- Department of Gastroenterology, Digestive Disease Surgery, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil
| | - Flavia Mori Sarti
- School of Public Health, University of Sao Paulo, Av Dr Arnaldo 715, Sao Paulo, SP, Brazil.,School of Arts, Sciences and Humanities, University of Sao Paulo, Av Arlindo Bettio 1000, Sao Paulo, SP, Brazil
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Van Prooyen AM, Hicks JL, Lin E, Davis SS, Singh A, Harris DA, Falconer EA, Hechenbleikner EM. Evaluation of An Inpatient Pharmacy Consult on Discharge Medications in Bariatric Surgery Patients. J Pharm Pract 2021; 36:203-212. [PMID: 34227420 DOI: 10.1177/08971900211030238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the impact of an inpatient pharmacy consult on discharge medications following bariatric surgery. METHODS A pharmacy consult for discharge medication review for bariatric surgery patients was instituted at an academic medical center. The intervention included conducting a medication history, reviewing home medications for updates post-bariatric surgery, creating and documenting a discharge medication plan, and providing patient education. The impact of the intervention was evaluated by comparing medication classes, doses, and formulations prescribed during the intervention relative to a historical control group. RESULTS The study included 85 patients who received pharmacist intervention and 167 patients who did not receive pharmacist intervention following bariatric surgery. The prescription of an extended-release medication at discharge in the intervention group was reduced by 19.3% (28.7% vs. 9.4%, p = 0.0005). For patients on hypertension medications, 94.0% had their regimen reduced in the intervention group compared with 37.5% of patients in the control group (p < 0.001). Of patients on insulin at baseline, 87.5% of patients in the intervention group had dose reductions at discharge vs. 66.7% of patients in the control group (p = 0.37). No patients in the intervention group were discharged with oral antihyperglycemic medications or non-insulin injectable medications vs. 33.3% (p = 0.12) and 20.0% (p = 0.47), respectively, in the control group. Readmission rates at 30 days were insignificantly lower in the intervention group (3.5% vs. 4.2%, p = 1). CONCLUSIONS Clinical pharmacist involvement in the discharge medication reconciliation process for bariatric surgery patients reduced prescribing of unadjusted medication classes, doses, and drug formulations.
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Affiliation(s)
| | - Jessica L Hicks
- Department of Pharmacy, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Ed Lin
- Division of General and GI Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Scott S Davis
- Division of General and GI Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Arvinpal Singh
- Division of General and GI Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - DeAngelo A Harris
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Elissa A Falconer
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Capoccia D, Coccia F, Guarisco G, Testa M, Rendina R, Abbatini F, Silecchia G, Leonetti F. Long-term Metabolic Effects of Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 28:2289-2296. [PMID: 29497961 DOI: 10.1007/s11695-018-3153-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Obesity is one of the major health challenges throughout the world. The association between obesity and diabetes is well established because 90% of patients with type 2 diabetes mellitus (T2DM) show excess body weight. The aim of the study was to evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on morbid obesity and type 2 diabetes (T2DM) in the long-term follow-up. METHODS One hundred ninety-five obese patients, 78 with T2DM, were evaluated before and after LSG up to 10 years, to identify complete diabetes remission (FPG < 100 mg/dl, A1c < 6.0%), partial remission (FPG 100-125 mg/dl, A1c < 6.5%), or relapse. RESULTS Before surgery, body weight and BMI were 123 ± 21 kg and 44.6 ± 6.8 kg/m2 respectively; at a mean follow-up of 7 years (range 4-10), body weight was 104.9 ± 18 kg and BMI 37 ± 6 kg/m2. Minimum weight was reached after 2 years. T2DM remission was observed in 66, 57, and 52% at short (< 2 years), medium (2-5 years), and long-term (> 5 years) follow-up respectively. Furthermore, 45.2% maintained complete remission for at least 5 years and about 36% showed a persistent but improved diabetes. None of the patients cured from diabetes had a duration disease greater than 8 years and a glycemic control requiring insulin. The prevalence of hypertension and dyslipidemia significantly decreased from 49 to 35% and from 51 to 40% respectively. CONCLUSIONS LSG significantly improves body weight, diabetes, hypertension, and dyslipidemia in long-term follow-up.
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Affiliation(s)
- Danila Capoccia
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Federica Coccia
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Gloria Guarisco
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Moira Testa
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Roberta Rendina
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Francesca Abbatini
- Department of Medical Surgical Sciences and Biotechnology, Division of General Surgery, ICOT, Sapienza University, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Gianfranco Silecchia
- Department of Medical Surgical Sciences and Biotechnology, Division of General Surgery, ICOT, Sapienza University, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Frida Leonetti
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
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Abstract
BACKGROUND Bariatric surgery is effective at achieving sustained weight loss and improving the control and resolution of obesity-related co-morbidities. Most studies that have demonstrated co-morbidity resolution in patients undergoing laparoscopic sleeve gastrectomy (LSG) only follow patients for the short term (less than 1 year) or follow a relatively small cohort (<100 patients) for the intermediate or long term (more than 5 years). We report our experience following a large cohort of morbidly obese patients who underwent LSG with intermediate-term follow-up. METHODS We retrospectively reviewed 435 consecutive patients who underwent LSG from January 2004 to November 2013. Co-morbidities investigated included diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia (HL). A co-morbidity was determined to be resolved if the patient was no longer taking any medication to treat that specific co-morbidity. RESULTS Mean follow-up was 26 ± 25 months (range = 1-112). Mean postoperative total weight loss (%TWL) at 6, 12, 24, 36, 48, 60, and 72 months were 23.6, 29.9, 29.5, 25.2, 26.7, 25.4, and 24.3 %, respectively. The incidence of all three co-morbidities was found to be significantly lower at the last patient follow-up. The resolution rates for DM, HTN, and HL were 59, 31, and 50 %, respectively. In patients who continued to have co-morbidities, the mean numbers of medications for DM (1.2 ± 0.7 vs. 0.5 ± 0.7, p < 0.0001), HTN (1.8 ± 1.1 vs. 1.3 ± 1.2, p < 0.0001), and HL (0.9 ± 0.7 vs. 0.6 ± 0.6, p < 0.0001) postoperatively were all significantly less. CONCLUSIONS LSG is effective at achieving significant and sustained weight loss, improvement in co-morbidity profiles, and a reduction in poly-pharmacy for these conditions over intermediate-term follow-up.
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Hood MM, Corsica J, Bradley L, Wilson R, Chirinos DA, Vivo A. Managing severe obesity: understanding and improving treatment adherence in bariatric surgery. J Behav Med 2016; 39:1092-1103. [PMID: 27444752 DOI: 10.1007/s10865-016-9772-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 07/12/2016] [Indexed: 01/11/2023]
Abstract
Severe obesity (body mass index ≥40 kg/m2) is a chronic disease that is associated with significantly increased risk of serious and chronic health problems as well as impaired quality of life. For those with severe obesity, bariatric surgery is the most effective treatment for significant and long-term weight loss and resolution of comorbid medical conditions, particularly diabetes. Long-term success is thought to depend to some degree on the patient's ability to adhere to a complex set of behaviors, including regular attendance at follow up appointments and following stringent dietary, exercise, and vitamin recommendations. Here, we summarize the current research on behavioral adherence in patients with severe obesity presenting for bariatric surgery and we highlight challenges and make recommendations for improved self-management before and after surgery.
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Affiliation(s)
- Megan M Hood
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA.
| | - Joyce Corsica
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Lauren Bradley
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Rebecca Wilson
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Diana A Chirinos
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Amanda Vivo
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
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