Length of stay by uncomplicated diabetes bariatric surgery patients: A laparoscopic adjustable banding versus laparoscopic sleeve gastrectomy.

RATIONALE, AIMS, AND OBJECTIVE: Bariatric surgery is an effective procedure for morbidly obese patients when all else fails. The purpose of this study was to compare the hospital length of stay (LOS) for two surgical procedures, laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG). METHODS: This study was a retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) from 2009 to 2014. Patients who received bariatric surgery as indicated by International Classification of Diseases, Ninth Revision (ICD-9) procedure codes were selected (N = 4001). Cases were limited to uncomplicated diabetic patients. Differences in the odds of long vs short (2< and ≥2) stay for a patient receiving LSG were compared with LAGB while adjusting for hospital volume, hospital size, patient age, gender, ethnicity, season, and year using logistic regression analysis. RESULTS: The odds for LSG (odds ratio [OR] = 0.100, 0.066-0.150, P < 0.001) patients for long LOS are lower when compared with LAGB. In the stratified logistic regression model, both male (OR = 0.157, 0.074-0.333, P < 0.001) and female (OR = 0.077, 0.046-0.127, P < 0.001) had reduced odds of extended LOS for LSG. Discharged patients in the year 2012 (OR = 0.660, 0.536-0.813, P < 0.001) had decreased odds of having a longer LOS when compared with the year 2014. Both government, nonfederal (OR = 0.452, 0.251-0.816, P = 0.008), and private investor-owned (OR = 0.421, 0.244-0.726, P < 0.001) patients had similar odds for long duration of stay when compared with government or private. Urban non-teaching (OR = 1.954, 1.653-2.310, P < 0.001) patients had higher odds for long LOS in comparison with urban teaching. New England patients' (OR = 0.365, 0.232-0.576, P < 0.001) odds for extended LOS were lower when compared with pacific. Both patients who received care in low (OR = 1.330, 1.109-1.595, P = 0.002) and medium (OR = 1.639, 1.130-2.377, P = 0.009) volume hospital had increased odds for long duration of stay. Female patients in the stratified logistic regression model with high (OR = 1.330, 1.109-1.595, P < 0.002) volume had elevated odds of extended LOS when compared with very low volume hospital. CONCLUSION: Among the uncomplicated diabetic patients, LSG provides a substantially low odds of extended LOS after adjusting for covariates when compared with LAGB. The finding of the relative reduction in LOS for LSG suggests opportunities for improvement both for cost reduction for third party insurance payers and greater efficacy and outcomes for patients.

Effects of a Web-based intervention for adults with chronic conditions on patient activation: online randomized controlled trial.

BACKGROUND: With almost one-half of Americans projected to have at least one chronic condition before 2020, a vital role of the health care system is to develop informed, engaged individuals who are effective self-managers of their health. Self-management interventions (SMIs) delivered face-to-face or by telephone (traditional SMIs) are associated with improved self-management knowledge, skills, and self-efficacy, which are expressed by the composite construct of patient activation, a predictor of health outcomes. Web-based interventions to support self-management across the spectrum of chronic diseases have the potential to reach a broader population of patients for extended periods than do traditional SMIs. However, evidence of the effectiveness of Web-based interventions on patient activation is sparse. High-quality studies featuring controlled comparisons of patients with different chronic conditions are needed to explore the interaction of Web-based interventions and patient activation. OBJECTIVE: To explore the effect of a Web-based intervention on the patient activation levels of patients with chronic health conditions, measured as attitudes toward knowledge, skills, and confidence in self-managing health. METHODS: For this 12-week study, prospective participants were selected from the patient panel of a regional health care system in the United States. The 201 eligible participants were randomly assigned to two groups. Intervention group participants had access to MyHealth Online, a patient portal featuring interactive health applications accessible via the Internet. Control participants had access to a health education website featuring various topics. Patient activation was assessed pre- and posttest using the 13-item patient activation measure. Parametric statistical models (t test, analysis of variance, analysis of covariance) were applied to draw inferences. RESULTS: The Web-based intervention demonstrated a positive and significant effect on the patient activation levels of participants in the intervention group. A significant difference in posttest patient activation scores was found between the two groups (F(1,123) = 4.438, P = .04, r = .196). Patients starting at the most advanced development of patient activation (stage 4) in the intervention group did not demonstrate significant change compared with participants beginning at earlier stages. CONCLUSIONS: To our knowledge, this is the first study to measure change in patient activation when a Web-based intervention is used by patients living with different chronic conditions. Results suggest that Web-based interventions increase patient activation and have the potential to enhance the self-management capabilities of the growing population of chronically ill people. Activated patients are more likely to adhere to recommended health care practices, which in turn leads to improved health outcomes. Designing Web-based interventions to target a specific stage of patient activation may optimize their effectiveness. For Web-based interventions to reach their potential as a key component of chronic disease management, evidence is needed that this technology produces benefits for a sustained period among a diverse population.