Obesity and Surgical Outcomes

肥胖和手术结果

• 批准号: 7271870
• 负责人: JEFFREY H SILBER
• 金额: $ 64.85万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-15 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7271870
• 关键词: Abscess; Absence of pain sensation; Address; Affect; Analgesics; Anastomosis - action; Anesthesia procedures; Anesthetics; Antibiotics; Blood Vessels; Breathing; Caring; Catheters; Cessation of life; Characteristics; Clinical; Clinical Data; Communities; Conduction Anesthesia; Data; Databases; Deep Vein Thrombosis; Development; Diagnosis; Early Ambulation; Elderly; Epidural Analgesia; Epidural Anesthesia; Etiology; Failure; Glucose; Guidelines; Height; Hospitals; Individual; Institution; Insurance Claim Review; Intravenous Anesthetics; Length of Stay; Literature; Measures; Medical; Medicare; Monitor; Non obese; Numbers; Nursing Records; Obesity; Operative Surgical Procedures; Opiates; Orthopedics; Ostomy; Outcome; Outcome Study; Pain; Pain management; Patient Care; Patients; Pattern; Perioperative; Perioperative Care; Play; Pneumonia; Population; Postoperative Hemorrhage; Postoperative Pain; Postoperative Period; Predictive Factor; Probability; Procedures; Pulmonary Embolism; Quality of life; Rate; Relative (related person); Research Infrastructure; Research Personnel; Rhabdomyolysis; Risk; Risk Factors; Role; Serum; Serum Albumin; Sleep Apnea Syndromes; Standards of Weights and Measures; Tail; Techniques; Technology; Testing; Thinking; Time; Time Study; Treatment outcome; Ventilatory Depression; Weight; Work; base; cohort; cost; day; design; dosage; hospital readmission; improved; mortality; older patient; prevent; programs; urologic

DESCRIPTION (provided by applicant): The overall aim of the Obesity and Surgical Outcomes (OBSOS) study is to improve the outcomes of obese patients who must undergo general, orthopedic, vascular or urological surgery. Obesity has been implicated in predisposing patients to worse surgical outcomes (death and complications), however, the etiology of these outcome differences is not well understood or well defined, and hence approaches to improving outcomes in this population are challenging. The application has 3 aims: (1) Determine how obesity influences the post operative outcomes of death, complications, failure-to-rescue (the probability of death after complications), length of stay, readmission rates, and cost; (2) Identify potential risk factors that may be especially important in treating obese as compared to non-obese patients, such as: control of serum glucose, use of preoperative antibiotics, early ambulation, and epidural analgesia; and (3) Determine whether there are differences or disparities in the care of obese patients undergoing surgery as compared to normal weight patients, such as differences in the surgical procedures offered, anesthesia technique and postoperative pain control. The study will use an efficient design that incorporates: (1) a three state, 50 hospital, Medicare "augmented claims analysis" that includes height, weight, and serum albumin information from charts (N=20,000), and (2) a nested, detailed chart abstraction (N=4000) using a matched cohort design to answer questions that require clinical data not available from Medicare claims. The infrastructure for this study will be supported by Medicare's SCIP (Surgical Care Improvement Program) initiative. By using augmented claims data with a nested, matched cohort abstraction of detailed chart data, we will be able to address clinically important problems in the care of obese surgical patients that will have a significant impact on the surgical approach to, and perioperative care of, the elderly obese. RELEVANCE: The rates of surgery on the elderly have doubled over the past 20 years, while the obesity rate in this same population has reached over 33%. Although often considered a surgical risk factor, the impact of obesity on surgical outcomes is poorly understood; studies have generally been small and from single institutions. The multi-institutional OBSOS study will examine differences in outcomes and treatments between obese and normal weight patients, and in so doing, should make important contributions to the care of these patients.

描述（由申请人提供）：肥胖与手术结果（OBSOS）研究的总体目标是改善必须接受普通、骨科、血管或泌尿外科手术的肥胖患者的结果。肥胖与患者手术结果较差（死亡和并发症）有关，然而，这些结果差异的病因尚不清楚或没有明确定义，因此改善该人群结果的方法具有挑战性。该应用程序有 3 个目标：(1) 确定肥胖如何影响死亡、并发症、抢救失败（并发症后死亡的概率）、住院时间、再入院率和费用等术后结果； (2) 识别与非肥胖患者相比对于治疗肥胖患者尤其重要的潜在危险因素，例如：血糖控制、术前抗生素的使用、早期下床活动和硬膜外镇痛； (3) 确定接受手术的肥胖患者与正常体重患者相比，在护理方面是否存在差异或差异，例如所提供的手术程序、麻醉技术和术后疼痛控制方面的差异。该研究将采用有效的设计，其中包括：(1) 三个州、50 家医院的 Medicare“增强索赔分析”，其中包括图表中的身高、体重和血清白蛋白信息 (N=20,000)，以及 (2) 嵌套，详细的图表抽象 (N=4000)，使用匹配的队列设计来回答需要医疗保险索赔中无法提供的临床数据的问题。这项研究的基础设施将得到 Medicare 的 SCIP（外科护理改进计划）计划的支持。通过使用增强的索赔数据和详细图表数据的嵌套、匹配队列抽象，我们将能够解决肥胖手术患者护理中的临床重要问题，这些问题将对手术方法和围手术期护理产生重大影响，老年人肥胖。相关性：过去 20 年来，老年人的手术率翻了一番，而同一人群的肥胖率已超过 33%。尽管肥胖经常被认为是手术危险因素，但人们对肥胖对手术结果的影响知之甚少。研究通常规模较小且来自单一机构。多机构 OBSOS 研究将检查肥胖患者和正常体重患者之间的结果和治疗差异，这样做应该为这些患者的护理做出重要贡献。