OBJECTIVE: This nationwide multicenter prospective observational cohort study compared CPOX monitoring with OSA-screening using PG.
METHODS: High-volume bariatric centers.
METHODS: Patients were either postoperatively monitored using CPOX without preoperative OSA-screening, or underwent preoperative PG and CPAP treatment when OSA was diagnosed. Cohort placement was based on local hospital protocols. Cost-effectiveness was analyzed using quality adjusted life years (QALYs) and healthcare costs. Surgical outcomes were also analyzed. Propensity score matching was used in sensitivity analyses.
RESULTS: A total of 1390 patients were included. QALYs were similar between groups at baseline and 1-year postoperatively. Postoperative complications, intensive care unit (ICU)-admissions and admissions, particularly OSA-related, did not differ between groups. Mean costs per patient/year in the CPOX group was €3094 versus €3680 in the PG group; mean difference €-586 (95% CI €-933-€-242). Following propensity score matching, 1090 of 1390 included patients remained, and similar findings for cost-effectiveness, complications, and ICU admissions were observed.
CONCLUSIONS: CPOX monitoring without preoperative OSA-screening was not associated with higher complication or readmission rates compared to PG. CPOX resulted in lower costs from a healthcare perspective and can therefore be considered a cost-effective alternative to routine OSA-screening in patients undergoing bariatric surgery.
目的:这项全国性的多中心前瞻性观察队列研究比较了CPOX监测和使用PG进行OSA筛查。
方法:高容量减肥中心。
方法:患者术后使用CPOX进行监测,没有术前OSA筛查,或在诊断为OSA时接受术前PG和CPAP治疗。队列的放置基于当地医院的协议。使用质量调整生命年(QALYs)和医疗保健成本分析成本效益。还分析了手术结果。在敏感性分析中使用倾向评分匹配。
结果:共纳入1390例患者。基线和术后1年组间的QALY相似。术后并发症,重症监护病房(ICU)-入院和入院,特别是与OSA相关的,组之间没有差异。CPOX组患者/年的平均费用为3094欧元,PG组为3680欧元;平均差异为-586欧元(95%CI-933--242欧元)。在倾向得分匹配之后,1390名患者中的1090名仍然存在,以及类似的成本效益调查结果,并发症,并观察ICU入院情况。
结论:与PG相比,没有术前OSA筛查的CPOX监测与更高的并发症或再入院率无关。从医疗保健的角度来看,CPOX降低了成本,因此可以被认为是接受减肥手术的患者常规OSA筛查的具有成本效益的替代方案。