Costs and usage of healthcare services before and after open bariatric surgery.

CONTEXT AND OBJECTIVE: Morbidly obese individuals are major consumers of healthcare services, with high associated costs. Bariatric surgery is an alternative for improving these individuals' comorbidities. There are no studies comparing costs before and after bariatric surgery in Brazil. The aim here was to analyze results relating to healthcare usage and direct costs among morbidly obese patients undergoing bariatric surgery. DESIGN AND SETTING: Historical cohort study on patients receiving healthcare through a private health plan in Belo Horizonte, Minas Gerais. METHODS: All healthcare services and their associated costs were included in the analysis: hospitalization, hospital stay, elective outpatient consultations, emergency service usage and examinations. The analyses were treated as total when including the whole years before and after surgery, or partial when excluding the three-month periods adjacent to the operation. RESULTS: For 382 obese patients who underwent open bariatric operations, there were 53 hospitalizations one year before and 95 one year after surgery (P = 0.013). Gastrointestinal complications were the main indications for post-procedure hospitalizations. The partial average cost almost doubled after the operation (US$ 391.96 versus US$ 678.31). In subgroup analysis, the costs from patients with gastrointestinal complications were almost four times greater after bariatric surgery. Even in the subgroup without complications, the partial average cost remained significantly higher. CONCLUSION: Although bariatric surgery is the only path towards sustained weight loss for morbidly obese patients, the direct costs over the first year after the procedure are greater. Further studies, with longer follow-up, might elucidate whether long-term reversal of this trend would occur.

Costs and usage of healthcare services before and after open bariatric surgery / Custos e utilização de serviços de saúde antes e após a cirurgia bariátrica por laparotomia

CONTEXT AND OBJECTIVE: Morbidly obese individuals are major consumers of healthcare services, with high associated costs. Bariatric surgery is an alternative for improving these individuals' comorbidities. There are no studies comparing costs before and after bariatric surgery in Brazil. The aim here was to analyze results relating to healthcare usage and direct costs among morbidly obese patients undergoing bariatric surgery. DESIGN AND SETTING: Historical cohort study on patients receiving healthcare through a private health plan in Belo Horizonte, Minas Gerais. METHODS: All healthcare services and their associated costs were included in the analysis: hospitalization, hospital stay, elective outpatient consultations, emergency service usage and examinations. The analyses were treated as total when including the whole years before and after surgery, or partial when excluding the three-month periods adjacent to the operation. RESULTS: For 382 obese patients who underwent open bariatric operations, there were 53 hospitalizations one year before and 95 one year after surgery (P = 0.013). Gastrointestinal complications were the main indications for post-procedure hospitalizations. The partial average cost almost doubled after the operation (US$ 391.96 versus US$ 678.31). In subgroup analysis, the costs from patients with gastrointestinal complications were almost four times greater after bariatric surgery. Even in the subgroup without complications, the partial average cost remained significantly higher. CONCLUSION: Although bariatric surgery is the only path towards sustained weight loss for morbidly obese patients, the direct costs over the first year after the procedure are greater. Further studies, with longer follow-up, might elucidate whether long-term reversal of this trend would occur.

CONTEXTO E OBJETIVO: Indivíduos obesos mórbidos são grandes consumidores de serviços de saúde, com altos custos associados. A cirurgia bariátrica é uma alternativa para melhorar suas comorbidades. Não existem estudos comparando custos antes e após a cirurgia bariátrica no Brasil. O objetivo deste estudo foi analisar os resultados assistenciais e gastos diretos de pacientes obesos mórbidos submetidos à cirurgia bariátrica. TIPO DE ESTUDO E LOCAL: Coorte histórica de pacientes assistidos por um plano de saúde na cidade de Belo Horizonte, Minas Gerais. MÉTODOS: Foram incluídos na análise todos os serviços de saúde e seus custos associados: hospitalizações, permanência hospitalar, consultas eletivas e de emergência e exames. A análise foi tratada como total quando incluía todo o ano anterior e posterior à cirurgia, e parcial quando excluía os trimestres adjacentes à cirurgia. RESULTADOS: Para 382 pacientes obesos operados, houve 53 internações um ano antes e 95 um ano após a cirurgia (P = 0,013). As principais indicações para internação pós-procedimento foram complicações relacionadas ao trato gastrointestinal. O custo parcial médio quase dobrou no período pós-operatório (US$ 391,96 versus US$ 678,31). Em análise de subgrupo, pacientes com complicações do trato gastrointestinal apresentaram custos quase quatro vezes maiores no período pós-bariátrica, e mesmo no subgrupo sem estas complicações, o custo parcial médio permaneceu significativamente maior. CONCLUSÃO: Embora a cirurgia bariátrica seja o único caminho para perda de peso sustentada nos pacientes obesos mórbidos, os custos diretos até um ano pós-procedimento são maiores. Novos estudos, com maior tempo de acompanhamento, poderão verificar se essa tendência se reverte no longo prazo.

Oral language comprehension assessment among elderly: a population based study in Brazil.

BACKGROUND: Determinants of oral language comprehension, a complex skill, are not clearly established, but may include age, schooling, health condition, depression and quality of life. OBJECTIVE: To assess oral comprehension skill among Brazilian elderly and identify factors explaining elderly variability in the Token test performance. METHODS: A population-based random sample of 373 elderly (> or = 60 years) in Belo Horizonte, 2007, answered standardized questionnaire including socio-demographic and health-related questions and performed the Token Test short version (SVTT), Snellen Test, Mini Mental State Examination, General Health Questionnaire, and Health Survey Short Form (SF12). RESULTS: Token Test scores ranged from 8 to 35 points; 50% of participants scored < or = 24 points with no sex variation. Age, schooling, literacy, cognitive status, hypertension, self-rated conversational understanding and SF12 mental component explained 62% of SVTT variability. CONCLUSIONS: Language comprehension disorder was quite common and test performance was highly influenced by education and cognitive status. Association between test performance and self-rated conversational comprehension indicated that elderly were aware of their difficulty.

Mortality and hospital stay after bariatric surgery in 2,167 patients: influence of the surgeon expertise.

BACKGROUND: Postoperative mortality is a rare event after bariatric surgery. The main goal of this study was to calculate the 30-day mortality rate postbariatric "open" surgery and the length of hospital stay of patients assisted by a health maintenance organization in Brazil. We also investigate their association with sex, age, BMI, preexisting comorbidities, and volume of procedures performed by surgeons. METHODS: A total of 2,167 patients who underwent RYGB between 01/2004 and 12/2007 were analyzed. The deaths and hospital stay were identified in the healthcare transactional database and the morbidity data in the preoperative medical audit records. Factors contributing to adverse outcomes were determined by multiple logistic regression analysis. RESULTS: The overall mortality rate was 0.64%, with a decreasing trend over the years. The median hospital stay was 3.1 days. In the multivariate analysis, both mortality and longer hospital stay were positively and significantly associated with age > 50 years, BMI > 50 kg/m(2), and surgeon volume of less than 20 bariatric surgeries/year. Presence of hypertension also increased the risk of longer hospital stay. Multivariate analysis showed that the 30-day mortality was six times higher in patients operated by professionals who performed less surgeries/year and longer hospital stay, four times more frequent. CONCLUSIONS: The 30-day mortality post-RYGB is similar to the rates found in developed countries and much lower than the rates found for patients assisted by the public health system in Brazil. In addition to age and clinical factors, the results suggest that mortality and longer hospital stay are strong and inversely related to surgeon's experience.

[The hospital bed referral center under the Unified National Health System in Belo Horizonte, Minas Gerais State, Brazil: the case of hospitalization for ischemic heart disease]. / Central de regulação de leitos do SUS em Belo Horizonte, Minas Gerais, Brasil: avaliação de seu papel pelo estudo das internações por doenças isquêmicas do coração.

The hospital admissions center in Belo Horizonte, Minas Gerais State, Brazil, aims to assure fast, timely, and equitable access to hospitalization services through the Unified National Health System. However, many patients are admitted directly to the hospitals, without going through the admissions center. This study compared the characteristics of hospitalizations in Belo Horizonte in 2002 according to type of access. All admissions for acute myocardial infarction and acute coronary disease were included. Of 3,705 admissions, 24.9% were processed through the hospital admissions center and 75.1% through direct access. Direct hospitalizations were more common as compared to processing by the hospital admissions center for patients>70 years), those with presumptive diagnosis of acute coronary disease, to the surgical department, and on weekends. Admissions via the hospital admissions center were more common than direct access for patients residing outside Belo Horizonte, at non-public hospitals, and for the intensive care unit. Length-of-stay also varied according to type of access. The results confirm differences in the characteristics of admissions according to the two types of access.

Central de regulação de leitos do SUS em Belo Horizonte, Minas Gerais, Brasil: avaliação de seu papel pelo estudo das internações por doenças isquêmicas do coração / The hospital bed referral center under the Unified National Health System in Belo Horizonte, Minas Gerais State, Brazil: the case of hospitalization for ischemic heart disease

A Central de Internações de Belo Horizonte, Minas Gerais, Brasil, visa tornar ágil o acesso às internações pelo Sistema Único de Saúde (SUS). Entretanto, muitas internações ocorrem diretamente nos hospitais, sem intermediação da Central de Internação. O estudo comparou as características das internações realizadas em 2002, com relação à via de acesso. Foram selecionadas internações com hipótese diagnóstica de infarto agudo do miocárdio e insuficiência coronariana aguda. De 3.705 internações, 24,9 por cento foram realizadas pela Central de Internação e 75,1 por cento por via direta. As proporções de internações via direta foram maiores que pela Central de Internação para pacientes > 70 anos, internados por insuficiência coronariana aguda, na clínica cirúrgica e no fim de semana. Os percentuais das internações via Central de Internação foram maiores que os feitos por via direta para residentes em outros municípios, em hospitais não públicos e com utilização de UTI. O número de dias de internação também foi diferente entre as vias. O estudo mostrou diferenças nas características das internações realizadas pelas duas vias de acesso.

The hospital admissions center in Belo Horizonte, Minas Gerais State, Brazil, aims to assure fast, timely, and equitable access to hospitalization services through the Unified National Health System. However, many patients are admitted directly to the hospitals, without going through the admissions center. This study compared the characteristics of hospitalizations in Belo Horizonte in 2002 according to type of access. All admissions for acute myocardial infarction and acute coronary disease were included. Of 3,705 admissions, 24.9 percent were processed through the hospital admissions center and 75.1 percent through direct access. Direct hospitalizations were more common as compared to processing by the hospital admissions center for patients > 70 years ), those with presumptive diagnosis of acute coronary disease, to the surgical department, and on weekends. Admissions via the hospital admissions center were more common than direct access for patients residing outside Belo Horizonte, at non-public hospitals, and for the intensive care unit. Length-of-stay also varied according to type of access. The results confirm differences in the characteristics of admissions according to the two types of access.