Hospital Transfer Between Primary and Secondary Metabolic Bariatric Surgery in The Netherlands
A Cross-sectional Multi-party Computation Analysis of Frequency and Associated Factors
Floris F.E. Bruinsma (Maastricht University Medical Center, Dutch Institute for Clinical Auditing)
Steven van Schuppen (Dutch Institute for Clinical Auditing)
Ronald S.L. Liem (Nederlandse Obesitas Kliniek, Groene Hart Hospital)
Perla J. Marang-van de Mheen (TU Delft - Safety and Security Science)
Simon W. Nienhuijs (Catharina Hospital)
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Abstract
Introduction: Some patients undergoing metabolic bariatric surgery (MBS) may transfer to another hospital for subsequent procedures. Due to legal constraints imposed by privacy regulations on inter-hospital data sharing, limited research has examined the characteristics and outcomes of these patients. This study aimed to identify the frequency and factors associated with hospital transfer using a novel privacy-enhancing approach based on secure multi-party computation (MPC). Methods: All primary and secondary MBS procedures registered in the Dutch Audit for Treatment of Obesity between January 1, 2014, and December 31, 2022, were considered. MPC enabled privacy-preserving linkage of surgeries across different hospitals. Patients undergoing secondary surgery in the same or a different hospital were compared on patient and treatment characteristics and outcomes of primary MBS to investigate associations with hospital transfer. Results: Two thousand three hundred eighty-two patients with data on both primary and secondary MBS were identified. A minority (n = 275; 11.5%) underwent their second procedure elsewhere. At baseline, these patients on average were younger (37.9 vs. 42.5, p < 0.001), less often had hypertension or GERD, and had similar BMI (43.9 vs 43.9, p = 0.89) compared with those who stayed. At secondary surgery, the BMI of patients transferring hospitals on average was lower (39.0 vs. 43.0, p < 0.001), and the indication was more often recurrent weight gain (49.0% vs. 23.0%, p < 0.001). Conclusion: A minority of patients (1 in 9) transferred to a different hospital for secondary MBS. These patients were generally younger and had fewer obesity-related diseases. Although they presented with a lower BMI at the time of secondary surgery, they more frequently sought surgery for recurrent weight gain.
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