Purpose. Anastomotic leaks (AL) present a significant source of clinical and economic burden on patients undergoing colorectal surgeries. This study was aimed at evaluating the clinical and economic consequences of AL and its risk factors. Methods. A retrospective cohort study was conducted between 2012 and 2013 based on the billing information of 337 patients who underwent low anterior resection (LAR). The outcomes evaluated were the development of AL, use of antibiotics, 30-day readmission and mortality, and total hospital costs, including readmissions and length of stay (LOS). The risk factors for AL, as well as the relationship between AL and clinical outcomes, were analyzed using multivariable Poisson regression. Generalized linear models (GLM) were employed to evaluate the association between AL and continuous outcomes (LOS and costs). Results. AL was detected in 6.8% of the patients. Emergency surgery (aRR 2.56; 95% CI: 1.15–5.71, p=0.021), blood transfusion (aRR 4.44; 95% CI: 1.86–10.64, p=0.001), and cancer diagnosis (aRR 2.51; 95% CI: 1.27–4.98, p=0.008) were found to be independent predictors of AL. Patients with AL showed higher antibiotic usage (aRR 1.69; 95% CI: 1.37–2.09, p<0.001), 30-day readmission (aRR 3.34; 95% CI: 1.53–7.32, p=0.003) and mortality (aRR 13.49; 95% CI: 4.10–44.35, p<0.001), and longer LOS (39.6 days, as opposed to 7.5 days for patients without AL, p<0.001). Total hospital costs amounted to R$210,105 for patients with AL in comparison with R$34,270 for patients without AL (p<0.001). In multivariable GLM, the total hospital costs for AL patients were 4.66 (95% CI: 3.38–6.23, p<0.001) times higher than those for patients without AL. Conclusions. AL leads to worse clinical outcomes and increases hospital costs by 4.66 times. The risk factors for AL were found to be emergency surgery, blood transfusion, and cancer diagnosis.
This study aimed to evaluate the effectiveness of only Roux-en-Y gastric bypass (RYGB) in patients with type 2 diabetes (T2D) and body mass index (BMI) of 30-40 kg/m. A literature search was performed on MEDLINE, Embase, and Cochrane CENTRAL. The searches were performed in February 2017. English was the target language of the publications. The PICO question was used to determine eligibility for studies to be included: population, patient with BMI 30-40 kg/m2; intervention, RYGB; comparison, control group with medical care alone; and outcome, metabolic outcomes. Only randomized clinical trials (RCT) were selected. The main outcome was T2D remission. Secondary outcomes were metabolic effect of RYGB, such as hypertension and dyslipidemia. A total of five RCTs were included. The studies included a larger proportion of women, and the average time of T2D duration ranged between 6 and 10 years with 43.3% of the patients having a BMI below 35 kg/m. Despite randomization, the baseline demographics such as age, HbA1c, and duration of diabetes were often less favorable in the surgical group. At the longest follow-up, RYGB significantly improves total and partial type 2 remission, OR 17.48 (95% CI 4.28-71.35) and OR 20.71 (95% CI 5.16-83.12), respectively. HbA1c also reduces at longest follow-up in the surgery group (- 1.83 (95% CI - 2.14; - 1.51)). All these three outcomes revealed high level of evidence according to GRADE evaluation. There is already strong evidence that RYGB improves metabolic outcomes for at least 5 years in patients with class I obesity.
BackgroundThis study aimed to evaluate the waiting time, safety, and effectiveness of bariatric surgery based on real-world data.MethodsThis is a noninterventional, noncomparative, and retrospective study with 300 morbidly obese patients who had undergone open Roux-en-Y surgery.ResultsThe procedure was found to be very safe, with low rates of overall complications (10.7%). Approximately 48.4% of the patients had reached a BMI <30 mg/kg2 at 12 months after surgery, while 6% were still classified as morbidly obese (BMI >40 mg/kg2). Comorbidity resolution was over 90% for all conditions, except for cardiovascular disease, which showed a 40% resolution. The mean number of drugs taken also decreased at 12 months after surgery.ConclusionsBariatric surgery was found to be effective in weight reduction and in the resolution of comorbidities.
BackgroundAtrial fibrillation (AF) is the most common arrhythmia worldwide, with significantly associated hospitalizations. Considering its growing incidence, the AF related economic burden to healthcare systems is increasing. Healthcare expenditures might be substantially reduced after AF radiofrequency ablation (AFRA).ObjectiveTo compare resource utilization and costs before and after AFRA in a cohort of patients from the Brazilian private healthcare system.MethodsWe conducted a retrospective cohort study, based on patients’ billing information from an administrative database. Eighty-three adult patients who had an AFRA procedure between 2014 and 2015 were included. Healthcare resource utilization related to cardiovascular causes, including ambulatory and hospital care, as well as its costs, were analyzed. A p-value of less than 0.05 was considered statistically significant.ResultsMean follow-up was 14.7 ± 7.1 and 10.7 ± 5.4 months before and after AFRA, respectively. The 1-year AF recurrence-free rate was 83.6%. Before AFRA, median monthly total costs were Brazilian Reais (BRL) 286 (interquartile range [IQR]: 137-766), which decreased by 63.5% (p = 0.001) after the procedure, to BRL 104 (IQR: 57-232). Costs were reduced both in the emergency (by 58.6%, p < 0.001) and outpatient settings (by 56%, p < 0.001); there were no significant differences in the outpatient visits, inpatient elective admissions and elective admission costs before and after AFRA. The monthly median emergency department visits were reduced (p < 0.001).ConclusionIn this cohort, overall healthcare costs were reduced by 63.5%. A longer follow-up could be useful to evaluate if long-term cost reduction is maintained.
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