Comparative analysis of short-term outcomes after bariatric surgery between two disparate populations
ABSTRACT Risk adjustment is a critically important aspect of outcomes research. Racial, geographic, cultural, and socioeconomic differences are nonclinical parameters that can affect clinical outcomes measurement after gastric bypass surgery.
A single surgeon's experience with 217 consecutive laparoscopic gastric bypass patients in private practice in Southern California was compared with the same surgeon's experience with 124 consecutive patients in an academic institution in Philadelphia.
Of the Southern California and Philadelphia groups, 89%, 1%, 9%, and 1% and 55%, 38%, 6%, and 0% were white, black, Hispanic, and Asian, respectively. The average number of co-morbidities was 7.8 in the Southern California group versus 14.4 in the Philadelphia group (P <.001). The 60-day readmission to the hospital rate and emergency room admission rate was 1.4% versus 10.4% and 1.4% versus 18.5%. The insurer mix of private pay, private insurer, and federally funded insurer was 20%, 80%, and 0% in the Southern California group and 0.8%, 71%, and 28% in the Philadelphia group, respectively. Multivariate logistic regression analysis found Medicaid status and practice location independently predicted for the 60-day readmission rate (odds ratio [OR] 3.7, P = .04 and OR 5.6, P = .04, respectively) and a return to the emergency room (OR 3.2, P = .03 and OR 16.3, P <.001). Race, income, and the presence of diabetes were not independent predictors. Variables with nonsignificant differences between the Southern California and Philadelphia cohorts included average age, average body mass index, and major complications (return to surgery and intensive care unit admissions).
The results of this study have shown that in comparing and predicting the outcomes after bariatric surgery, adjustment for demographic and insurance variables might be necessary to improve accuracy.
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ABSTRACT: To analyze the socioeconomics of the morbidly obese patient population and the impact on access to bariatric surgery using 2 nationally representative databases. Bariatric surgery is a life-changing and potentially life-saving intervention for morbid obesity. Access to bariatric surgical care among eligible patients might be adversely affected by a variety of socioeconomic factors. The national bariatric eligible population was identified from the 2005-2006 National Health and Nutrition Examination Survey and compared with the adult noneligible population. The eligible cohort was then compared with patients who had undergone bariatric surgery in the 2006 Nationwide Inpatient Sample, and key socioeconomic disparities were identified and analyzed. A total of 22,151,116 people were identified as eligible for bariatric surgery using the National Institutes of Health criteria. Compared with the noneligible group, the bariatric eligible group had significantly lower family incomes, lower education levels, less access to healthcare, and a greater proportion of nonwhite race (all P <.001). Bariatric eligibility was associated with significant adverse economic and health-related markers, including days of work lost (5 versus 8 days, P <.001). More than one third (35%) of bariatric eligible patients were either uninsured or underinsured, and 15% had incomes less than the poverty level. A total of 87,749 in-patient bariatric surgical procedures were performed in 2006. Most were performed in white patients (75%) with greater median incomes (80%) and private insurance (82%). Significant disparities associated with a decreased likelihood of undergoing bariatric surgery were noted by race, income, insurance type, and gender. Socioeconomic factors play a major role in determining who does and does not undergo bariatric surgery, despite medical eligibility. Significant disparities according to race, income, education level, and insurance type continue to exist and should prompt focused public health efforts aimed at equalizing and expanding access.Surgery for Obesity and Related Diseases 07/2009; 6(1):8-15. DOI:10.1016/j.soard.2009.07.003
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ABSTRACT: A study has been performed of a special type of SAWs on piezoelectric substrates that propagate faster than slow quasi transverse bulk waves (QTBW) without leaking into the substrate. Properties of these SAWs resemble, to some extent, those of the SH-polarized Gulyaev-Bleustein wave (GBW) and we refer to them as fast generalized GBW (GGBW). A remarkable specific feature is that fast GGBW can exist on a piezoelectric medium of generic symmetry. They originate because of piezoelectric coupling and can be viewed as the issue of the "localization" of exceptional bulk waves (EBW) that appear in the branch of fast QTBW in the limit of vanishing piezomoduli.Ultrasonics Symposium, 2002. Proceedings. 2002 IEEE; 11/2002
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ABSTRACT: Multiple electromigration failure mechanism was observed in advanced dual damascene Cu interconnects. The complex failure behaviors make precision lifetime prediction more challenging. In the present work, multi-modality electromigration behavior of Cu dual damascene interconnects were studied. Both superposition and weak link models were used for statistical determination of lifetimes of each failure model (statistical method). Results were correlated to the lifetimes of respective failure models physically identified according to resistance time evolution behaviors (Physical method). Good agreement was achieved.Integrated Reliability Workshop Final Report, 2002. IEEE International; 11/2002