RESUMO
BACKGROUND: For several types of non-cardiac surgery, the cardiopulmonary exercise testing (CPET)-derived variables anaerobic threshold (AT), peak oxygen consumption (VO2 peak), and ventilatory equivalent for CO(2) (VE/VCO2 ) are predictive of increased postoperative risk: less physically fit patients having a greater risk of adverse outcome. We investigated this relationship in patients undergoing gastric bypass surgery. METHODS: All patients (<190 kg) who were referred for CPET and underwent elective gastric bypass surgery at the Whittington Hospital NHS Trust between September 1, 2009, and February 25, 2011, were included in the study (n=121). Fifteen patients did not complete CPET. CPET variables (VO2 peak, AT, and VE/VCO2 ) were derived for 106 patients. The primary outcome variables were day 5 morbidity and hospital length of stay (LOS). The independent t-test and Fisher's exact test were used to test for differences between surgical outcome groups. The predictive capacity of CPET markers was determined using receiver operating characteristic (ROC) curves. RESULTS: The AT was lower in patients with postoperative complications than in those without [9.9 (1.5) vs 11.1 (1.7) ml kg(-1) min(-1), P=0.049] and in patients with a LOS>3 days compared with LOS ≤ 3 days [10.4 (1.4) vs 11.3 (1.8) ml kg(-1) min(-1), P=0.023]. ROC curve analysis identified AT as a significant predictor of LOS>3 days (AUC 0.640, P=0.030). The VO2 peak and VE/VCO2 were not associated with postoperative outcome. CONCLUSIONS: AT, determined using CPET, predicts LOS after gastric bypass surgery.
Assuntos
Teste de Esforço/métodos , Derivação Gástrica , Adulto , Limiar Anaeróbio/fisiologia , Área Sob a Curva , Peso Corporal/fisiologia , Feminino , Humanos , Tempo de Internação , Masculino , Readmissão do Paciente , Aptidão Física , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Resultado do TratamentoRESUMO
The field of health care is moving very quickly, developing new technologies and diagnostics as well as devising new ways to pay for this technology. This article deals with one particular, rapidly evolving payment mechanism, namely, the Preferred Provider Organization (PPO). The analysis below describes the growth of the PPO, both in the medical field and in the current general marketplace, and examines its future. Creative approaches to designing PPOs are also discussed. Finally, this article offers some suggestions on ensuring the viability of PPOs.
Assuntos
Seguro Saúde/organização & administração , Propriedade , Organizações de Prestadores Preferenciais/organização & administração , Coleta de Dados , Indústrias , Estados UnidosRESUMO
Last year, Caterpillar Tractor Company in Peoria, Ill. paid 90 percent of the health care costs for approximately one quarter of a million persons in the United States. Here, the author reviews what Caterpillar is doing to curb these costs, which have been increasing at a rate greater than inflation.
