HEALTH CARE UTILIZATION AND COSTS OF BARIATRIC SURGERY PATIENTS WITH VS. WITHOUT COMORBID OBSTRUCTIVE SLEEP APNEA
Bibliographic record
Abstract
Obstructive sleep apnea (OSA) is underrecognized. Between 10% and 69% of preoperative patients have undiagnosed OSA. To reduce the risk of peri-operative complications related to undiagnosed OSA, patients planned to undergo bariatric surgery are screened for OSA. To understand the OSA detection rate with screening practices, the prevalence of OSA within patients who underwent publicly funded bariatric surgery in Ontario between 2010 and 2016 was measured. Secondly, to understand the effect of OSA screening practices on perioperative and longer-term health care costs, health care utilization and costs were compared between patients with OSA and matched patients without OSA in the 30 days post-bariatric surgery, as well as in the 1 year post-bariatric surgery. The Ontario Bariatric Registry (OBR) linked to the ICES health administrative databases were used. A diagnosis of OSA was identified if recorded in the OBR at time of initial bariatric consultation, or if recorded in ICES databases from the bariatric surgery admission records. Costs were calculated based on the “Guidelines on Person-Level Costing Using Administrative Databases in Ontario” using ICES costing algorithms. The overall prevalence of OSA was 47% (95% CI 46% to 47%). Total health care costs per patient, in the 30-day post-operative period, were 1% lower (95% CI 1% to 1%, p < 0.001) in patients with OSA compared to matched patients without OSA. Similarly, at 1 year postbariatric surgery, total health care costs per patient, were 1% lower (95% CI 1% to 1%, p < 0.001) in patients with OSA compared to matched patients without OSA. At 30 days and 1 year, this difference was driven by lower hospitalization-related costs. OSA screening practices at surgical centers in our network led to similar rates of OSA detection as reported in the literature. However, the literature suggests that screening practices lead to missed OSA diagnoses. Further study is required to understand the reduced post-bariatric surgery costs in patients with OSA compared to matched controls without OSA; and, we postulate that missed OSA diagnoses may be a contributor.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".