Background
Methods
Study design
Bariatric surgery characteristics
Sample
Variables
Variable | Components |
---|---|
Health outcomes | Anthropometric measures (weight and height); Hemodynamic measures (blood pressure); Biochemical exams (cholesterol and fractions, triglycerides, insulin, glucose-linked haemoglobin, and fasting glucose). |
Health care costs | Outpatient health care: • Appointments with health professionals; • Clinical assessment; • Diagnostic exams. Inpatient health care referring to intervention (bariatric surgery) and obesity-related procedures pre-and post-intervention: • Hospital length of stay; • Type of surgery; • Inpatient procedures; • Use of resources including the operating room, medication, meals, human resources, hemodynamic and biochemical exams. |
Health outcomes
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Weight (kg);
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BMI (kg/m [2]);
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Blood pressure (mmHg);
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Cholesterol (mg/dL);
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VLDL (mg/dL);
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LDL (mg/dL);
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HDL (mg/dL);
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Triglycerides (mg/dL);
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Insulin (IU/mL);
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Glucose-linked haemoglobin (%);
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Fasting glucose (mg/dL)
Health care costs
Statistical analysis
Results
Characteristics of patients at baseline, intervention and follow-up
Gender | N | (%) | |
---|---|---|---|
Men | 9 | 7.9 | |
Women | 95 | 83.3 | |
Age (μ±SD) | 47.8 ± 14.1 | ||
Lifestyle characteristics | |||
Tobacco use | 20 | 17.5 | |
Alcohol consumption | 0 | 0.0 | |
Comorbidity | N | (%) | |
Hypertension | 72 | 63.2 | |
T2DM | 67 | 58.8 | |
Sleep apnea | 31 | 27.2 | |
Dyslipidemia | 25 | 21.9 | |
Arthrosis | 25 | 21.9 | |
Hypothyroidism | 10 | 8.8 | |
Varices | 10 | 8.8 | |
CRI | 10 | 8.8 | |
CCI | 5 | 4.4 | |
Type of surgery | N | (%) | |
Y-Roux gastric by-pass | Open | 67 | 58.8 |
Video laparoscopic | 34 | 29.8 | |
Sleeve (vertical gastrectomy) | Open | 4 | 3.5 |
Video laparoscopic | 3 | 2.6 | |
Adjustable gastric banding | Open | 3 | 2.6 |
Video laparoscopic | 3 | 2.6 |
Health outcomes | Pre-surgery μ (±SD) | Post-surgery μ (±SD) | P | Cost per unit change (US$) |
Weight (kg) | 125.53 (±18.58) | 103.23 (±24.46) | <0.001 | 61.68 |
BMI (kg/m [2]) | 47.36 (±4.22) | 39.01 (±7.26) | <0.001 | 164.71 |
Blood pressure (mmHg) | 132 (±15.21) | 126.51 (±17.36) | 0.0025 | 250.52 |
Cholesterol (mg/dL) | 165.11 (±39.9) | 167.78 (±38.55) | 0.8341 | 515.12 |
VLDL (mg/dL) | 21.51 (±8.33) | 22.91 (±8.93) | <0.001 | 982.41 |
LDL (mg/dL) | 94.06 (±34.66) | 93.2 (±34.58) | 0.0147 | 1,599.27 |
HDL (mg/dL) | 45.63 (±14.38) | 51.88 (±13.23) | <0.001 | 220.06 |
Triglycerides (mg/dL) | 130.67 (±64.21) | 117.27 (±56.95) | <0.001 | 102.64 |
Insulin (IU/mL) | 17.19 (±22.55) | 12.69 (±7.47) | <0.001 | 305.64 |
Glucose-linked hemoglobin (%) | 127.57 (±43.88) | 113.61 (±36.47) | 0.001 | 98.52 |
Fasting glucose (mg/dL) | 113.22 (±45.77) | 99.11 (±39.83) | <0.001 | 97.47 |
Health care costs | Pre-surgery μ (±SD) | Post-surgery μ (±SD) | P | Cost per unit change (US$) |
Consultations | 17.64 (±13.9) | 18.06 (±15.32) | <0.001 | 3,274.69 |
Inpatient days* | 11,913.26 (±12,682.01) | 9,151.04 (±9,695.16) | <0.001 | 0.50 |
Laboratory exams | 108.72 (±112.94) | 177.68 (±217.78) | <0.001 | 19.94 |
Image exams | 888.99 (±901.22) | 881.46 (±854.78) | 0.0161 | 182.65 |
Medication | 683.9 (±854.73) | 508.45 (±696.99) | <0.001 | 7.84 |
Total direct costs | 996.61 (±4,515.39) | 2,371.98 (±6,172.79) | <0.001 | - |
Changes between pre-and post-intervention using ITSA
Health outcomes | Cons | Pre | Int | Post | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Coef | 95% CI | P* | Coef | 95% CI | P* | Coef | 95% CI | P* | ||
Weight | 133.7986 | 0.0053 | (-.0029; 0.0134) | 0.208 | -15.7546 | (-20.9373; -10.5312) | <0.001 | -0.0324 | (-0.0441; -0.0205) | <0.001 |
BMI | 53.6564 | -0.0024 | (-0.0025; 0.0029) | 0.894 | 4.4470 | (2.0075; 7.4842) | 0.001 | -0.0158 | (-0.0256; -0.0162) | <0.001 |
Blood pressure | 132.7641 | -0.0024 | (-0.0081; 0.0032) | 0.402 | 0.4449 | (-3.2024; 4.0685) | 0.815 | -0.0061 | (-0.0140; 0.0018) | 0.131 |
Cholesterol | 157.4912 | -0.0170 | (-0.0331; -0.0008) | 0.039 | 7.1876 | (-0.8418; 15.1757) | 0.079 | 0.0186 | (-0.0013; 0.0385) | 0.066 |
VLDL | 19.3720 | 0.0043 | (0.0014; 0.0072) | 0.004 | 3.1873 | (1.3006; 5.0683) | 0.001 | -0.0124 | (-0.0164; -0.0085) | <0.001 |
LDL | 93.4065 | -0.0093 | (-0.0233; 0.0047) | 0.194 | 9.2046 | (1.8887; 16.5348) | 0.014 | -0.0080 | (-0.0257; 0.0096) | 0.373 |
HDL | 33.0861 | 0.0212 | (0.0156; 0.0268) | <0.001 | -8.5178 | (-11.6697; -5.3983) | <0.001 | -0.0024 | (-0.0098; 0.0049) | 0.523 |
Triglycerides | 108.6332 | 0.0231 | (-0.0066; 0.0528) | 0.128 | 0.4112 | (-17.1356; 17.8948) | 0.966 | -0.0775 | (-0.1176; -0.0375) | <0.001 |
Insulin | 9.9325 | 0.0150 | (0.0108; 0.0193) | <0.001 | -5.2224 | (-7.4075; -3.0374) | <0.001 | -0.0209 | (-0.0263; -0.0156) | <0.001 |
Glucose-linked haemoglobin | 126.1915 | 0.0038 | (-0.0156; 0.0231) | 0.703 | -3.6614 | (-14.8040; 7.4856) | 0.520 | -0.0326 | (-0.0580; -0.0071) | 0.012 |
Fasting glucose | 101.4913 | 0.0343 | (0.0143; 0.0545) | 0.001 | -12.6732 | (-23.9196; -1.4268) | 0.027 | -0.0719 | (-0.0954; -0.0485) | <0.001 |
Direct costs | 180.27 | 0.8673 | (0.0750; 1.6596) | 0.032 | 4,700.29 | (3,452.16; 5,948.43) | <0.001 | -10.2397 | (-12.5172; -7.9624) | <0.001 |
Post-intervention linear trends
Health outcomes | Post intervention trend | CI 95% | p |
---|---|---|---|
Weight | -0.0271 | (-0.0356;-0.0186) | <0.001 |
BMI | -0.0208 | (-0.0246;-0.0169) | <0.001 |
Blood pressure | -0.0085 | (-0.0141;-0.0030) | 0.0025 |
Cholesterol | 0.0016 | (-0.0100;0.0133) | 0.7820 |
VLDL | -0.0082 | (-0.0108;-0.0055) | <0.001 |
LDL | -0.0173 | (-0.0281;-0.0066) | 0.0016 |
HDL | 0.0188 | (0.0150;0.0226) | <0.001 |
Triglycerides | -0.0544 | (-0.0755;-0.0334) | <0.001 |
Insulin | -0.0058 | (-0.0083;-0.0034) | <0.001 |
Glucose-linked hemoglobin | -0.0288 | (-0.0414;-0.0162) | 0.001 |
Fasting glucose | -0.0376 | (-0.0470;-0.0281) | <0.001 |
Total direct cost | -9.3725 | (-11.5077;-7.2373) | <0.001 |
Consultations | -0.0113 | (-0.0170;-0.0056) | 0.001 |
Hospitalizations | -8.5584 | (-10.6245;-6.4924) | <0.001 |
Laboratory exams | -0.2202 | (-0.2797;-0.1608) | <0.001 |
Image exams | -0.1059 | (-0.1923;-0.0194) | 0.0164 |
Medication | -0.4767 | (-0.6364;-0.3170) | <0.001 |
Health Outcomes | Characteristics | Dy/dx | 95%CI | P |
BMI | Pre | 0.003 | (0.001; 0.005) | <0.001 |
Int | 0.803 | (0.006; 0.154) | 0.033 | |
Post | -0.0006 | (-0.0008; -0.0004) | <0.001 | |
Gender (female) | -0.005 | (-0.034; 0.024) | 0.744 | |
Age | 0.0007 | (-2.855; 3.001) | 0.105 | |
Weight | Pre | 0.002 | (-0.01; -0.01) | 0.804 |
Int | -58.404 | (-69.9; -46.9) | <0.001 | |
Post | 0.086 | (0.06; -0.1) | <0.001 | |
Gender (female) | -4.286 | (-5.29; -3.27) | <0.001 | |
Age | -0.12 | (-0.15; -0.08) | <0.001 | |
Blood pressure | Pre | -0.002 | (-0.005; 0.001) | 0.167 |
Int | 0.522 | (-1.66; 2.71) | 0.640 | |
Post | -0.006 | (-0.01; -0.001) | 0.007 | |
Gender (female) | 0.221 | (-1.6; 2.04) | 0.812 | |
Age | 0.007 | (-0.04; 0.06) | 0.808 | |
Cholesterol | Pre | -0.03 | (-0.04; -0.01) | <0.001 |
Int | 6.047 | (-0.78; 12.87) | 0.083 | |
Post | 0.046 | (0.03; 0.06) | <0.001 | |
Gender (female) | 9.214 | (7.43; 10.98) | <0.001 | |
Age | 0.121 | (0.06; 0.17) | <0.001 | |
VLDL | Pre | 0.007 | (0.003; 0.01) | <0.001 |
Int | 1.784 | (0.14; 3.42) | 0.033 | |
Post | -0.014 | (-0.01; -0.01) | <0.001 | |
Gender (female) | -0.108 | (-0.75; 0.54) | 0.744 | |
Age | 0.016 | (-0.003; 0.03) | 0.105 | |
LDL | Pre | -0.017 | (-0.02; -0.006) | 0.002 |
Int | -1.776 | (-7.95; 4.39) | 0.573 | |
Post | 0.033 | (0.01; 0.04) | <0.001 | |
Gender (female) | 6.900 | (5.58; 8.21) | <0.001 | |
Age | -0.039 | (-0.07; -0.0001) | 0.049 | |
HDL | Pre | 0.022 | (0.01; 0.02) | <0.001 |
Int | -8.427 | (-10.16; -6.69) | <0.001 | |
Post | -0.005 | (-0.008; -0.0006) | 0.023 | |
Gender (female) | 1.125 | (0.14; 2.1) | 0.024 | |
Age | 0.092 | (0.06; 0.12) | <0.001 | |
Triglycerides | Pre | 0.051 | (0.04; 0.06) | <0.001 |
Int | -6.802 | (-11.98; -1.61) | 0.01 | |
Post | -0.111 | (-0.12; -0.09) | <0.001 | |
Gender (female) | 6.805 | (5.27; 8.33) | <0.001 | |
Age | 0.18 | (0.13; 0.22) | <0.001 | |
Insulin | Pre | 0.014 | (0.01; 0.01) | <0.001 |
Int | -7.207 | (-9.05; -5.35) | <0.001 | |
Post | -0.017 | (-0.02; 0.01) | <0.001 | |
Gender (female) | 0.207 | (-0.3; 0.71) | 0.427 | |
Age | -0.001 | (-0.01; 0.01) | 0.885 | |
Glucose-linked haemoglobin | Pre | 0.013 | (0.003; 0.02) | 0.007 |
Int | -3.227 | (-8.41; 1.96) | 0.223 | |
Post | -0.051 | (-0.06; 0.03) | <0.001 | |
Gender (female) | 4.468 | (2.96; 5.97) | <0.001 | |
Age | -0.011 | (-0.05; 0.03) | 0.643 | |
Fasting glucose | Pre | 0.019 | (0.006; 0.03) | 0.003 |
Int | 8.873 | (1.76; 15.98) | 0.014 | |
Post | -0.095 | (-0.11; -0.07) | <0.001 | |
Gender (female) | 6.721 | (5.37; 8.06) | <0.001 | |
Age | 0.119 | (0.07; 0.15) | <0.001 | |
Health Care Costs | Characteristics | Dy/dx | 95%CI | P |
Direct cost | Pre | 1.153 | (1.12; 1.17) | <0.001 |
Int | 1189.518 | (1179.29; 1199.74) | <0.001 | |
Post | -4.323 | (-4.35; -4.29) | <0.001 | |
Gender (female) | -100.838 | (-103.32; -98.34) | <0.001 | |
Age | 1.303 | (1.22; 1.38) | <0.001 |