RESUMO
BACKGROUND: This is an exploratory analysis of potential variables associated with open Roux-en-Y gastric bypass (RYGB) surgery hospitalization resource use pattern. METHODS: Cross-sectional study based on an administrative database (DATASUS) records. Inclusion criteria were adult patients undergoing RYGB between Jan/2008 and Jun/2011. Dependent variables were length of stay (LoS) and ICU need. Independent variables were: gender, age, region, hospital volume, surgery at certified center of excellence (CoE) by the Surgical Review Corporation (SRC), teaching hospital, and year of hospitalization. Univariate and multivariate analysis (logistic regression for ICU need and linear regression for length of stay) were performed. RESULTS: Data from 13,069 surgeries were analyzed. In crude analysis, hospital volume was the most impactful variable associated with log-transformed LoS (1.312 ± 0.302 high volume vs. 1.670 ± 0.581 low volume, p < 0.001), whereas for ICU need it was certified CoE (odds ratio (OR), 0.016; 95% confidence interval (CI), 0.010-0.026). After adjustment by logistic regression, certified CoE remained as the strongest predictor of ICU need (OR, 0.011; 95% CI, 0.007-0.018), followed by hospital volume (OR, 3.096; 95% CI, 2.861-3.350). Age group, male gender, and teaching hospital were also significantly associated (p < 0.001). For log-transformed LoS, final model includes hospital volume (coefficient, -0.223; 95% CI, -0.250 to -0.196) and teaching hospital (coefficient, 0.375; 95% CI, 0.351-0.398). Region of Brazil was not associated with any of the outcomes. CONCLUSIONS: High-volume hospital was the strongest predictor for shorter LoS, whereas SRC certification was the strongest predictor of lower ICU need. Public health policies targeting an increase of efficiency and patient access to the procedure should take into account these results.
Assuntos
Derivação Gástrica/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Obesidade Mórbida/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Seleção de Pacientes , Fatores de RiscoRESUMO
The anatomical and physiological changes of the gastrointestinal tract after Roux-en-Y gastric bypass lead to changes in dietary patterns and their effects are still little known. Hence, the objective of this work was to characterize the prevalence, the associated factors and the list of food aversions with the effect of surgery on the body weight of women in the first two years after Roux-en-Y gastric bypass. A total of 141 women were studied. Their food aversions were assessed with a short food frequency questionnaire (FFQ-S) containing 26 items before and 6, 12 and 24 months after surgery. The FFQ-S was filled out during individual interviews and referenced in the medical records. The association between total aversion score and body weight variables and general characteristics of the group was analyzed. Variation of food aversions over time was assessed for 26 foods individually and grouped. Of all the studied variables, a weak but significant negative correlation (rs = -0.1944; p = 0.0208) was found between total aversion score and shorter postoperative period and a weak but significant positive correlation was found between total aversion score and percentage of weight regained (rs = -0.1759; p = 0.0369). Food aversions were more common in the first six months after surgery, especially to red meats, rice, chicken, eggs, pasta, milk and others. Food aversions in the early postoperative period are associated with weight variations in the first two years after surgery and subside significantly over time, probably because of a physiological and cognitive adaptation of the individual to the surgical procedure.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Derivação Gástrica/efeitos adversos , Obesidade/cirurgia , Adulto , Idoso , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores de Tempo , Adulto JovemRESUMO
Este estudo teve como objetivos avaliar a taxa metabólica basal (TMB) de mulheres com obesidade mórbida residentes no interior do Estado de São Paulo, Brasil, comparando a TMB medida por calorimetria indireta com a TMB calculada usando as equações de Harris-Benediet e da Food Agriculture Organization 1 World Heaith Organization (FAOIWHO), e determinar se é importante a medida da TMB por calorimetria indireta, para elaboração de programas para redução de peso com dieta e exercício nesta população. A taxa metabólica basal de 20 pacientes com obesidade mórbida (IMC, 40,3 a 64,3 kdm'), com idade média de 39,3 anos (DP = 6,4), foi medida por calorimetria indireta e comparada com a TMB calculada pelas equações de predição de Harris-Benedict e FAOIWHO. Foi realizado um estudo de reprodutibilidade o calculado os coefici- entes de correlação intraciasses para comparar a TMB medida com as calculadas por equações. A média da TMB medida por calorimetria indireta foi de 2023,0 kcal/dia (DP = 401,9), e não houve concordância com as equações de predição de Harris-Benedict (p = 0,08) e FAOIWHO (p = 0,08). Concluímos que as equações de predição de Harris-Benedict e FAOIWHO não permitem uma estimativa real da taxa metabólica basal de mulheres com obesidade mórbida residentes no interior do estado de São Paulo. Portanto, a mensuração da taxa metabólica basal por calorimetria indireta, nestas pacientes, é importante para elaboração de programas para redução de peso corporal com dieta e exercício.