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減量外科手術後の20年間,ヘルスケアの利用
Martin Neovius1, Kristina Narbro, Catherine Keating
1Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. martin.neovius@ki.se
JAMA
|September 20, 2012
まとめ
腹腔外科手術の患者は当初,医療費の利用率が高くなったが,長期的には薬費が下がった. 20年以上にわたり,外科手術は当初,入院および外来治療の増加につながったが,経費はバランスをとり,後に薬費が減った.
科学分野:
- 減量手術の結果について
- 長期医療利用について
- 肥満治療の効果について
背景:
- 減量手術は,持続的な体重減少を促進し,糖尿病,心血管疾患,がん,死亡率のリスクを軽減します.
- 医療利用に対する減量手術の長期的な影響は,依然としてほとんど不明です.
- スウェーデンの肥満被験者 (SOS) 研究は,減量外科手術の結果に関するユニークな長期的な視点を提供します.
研究 の 目的:
- バリアトリック手術で治療された肥満患者の20年間の医療利用率を評価し,従来の肥満管理と比較する.
- 2つのグループ間の入院病院日数,非プライマリケアの外科医診察,および薬費の違いを評価する.
主な方法:
- 2010年の低脂肪手術患者と2037人のマッチングした対照群を対象とした前向きな,ランダム化されていない,制御された介入研究 (スウェーデン肥満患者研究) です.
- スウェーデンの国家登録から20年以上にわたり,入院日数,外来診察,医薬品費用に関するデータを収集した.
- 年齢,性別,BMI,糖尿病状態を含むベースライン特性を調整した統計分析.
主要な成果:
- 腹腔外科手術の患者は,当初,対照群と比較して,入院 (2~6年) と非プライマリの外科治療の利用率が高かった.
- 最初の6年間の期間を経て,入院・外来患者のケア利用は,手術と対照群の間で類似するようになった.
- 7歳から20歳までの低精度外科手術の患者は,対照群と比較して,年間薬費 (平均差 -228ドル) が著しく低下しました.
結論:
- 腹腔外科手術は,初期医療利用率の増加と関連しているが,長期的にはそうではない.
- 長期の薬費は,通常の治療を受けている患者と比較して,減量外科手術を受けた患者で著しく低くなります.
- これらの発見は,整体的なヘルスケアリソースの利用に対する減量外科手術の複雑で時間に依存する影響を強調しています.
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