Pay for obesity? Pay-for-performance metrics neglect increased complication rates and cost for obese patients

Hirose, Kenzo; Shore, Andrew; Wick, Elizabeth; Weiner, Jonathan; Makary, Martin; Shore, Andrew D; Wick, Elizabeth C; Weiner, Jonathan P; Makary, Martin A
July 2011
Journal of Gastrointestinal Surgery;Jul2011, Vol. 15 Issue 7, p1128
Academic Journal
journal article
Background: Rates of surgical complications are increasingly being used for pay-for-performance reimbursement structures. We hypothesize that morbid obesity has a significant effect on complication rates and costs following commonly performed general surgical procedures.Methods: We studied 30,502 patients who underwent cholecystectomy for cholecystitis and 6,390 patients who underwent appendectomy for acute appendicitis using administrative claims data from seven Blue Cross and Blue Shield Plans over a 7-year period (2002-2008). We compared 30-day complications as well as total 30-day direct medical costs for obese and non-obese patients. Multivariate regressions were performed to determine the relationship of morbid obesity to complications and cost.Results: Obese patients were more likely to have a complication within 30 days after surgery than non-obese patients (19.2% vs. 15.7% for cholecystectomy, p < 0.0001; 20.2% vs. 15.2%, p < 0.0001, for appendectomy). The mean total 30-day postoperative cost for obese patients were $1,109 higher following a cholecystectomy (p < 0.0001) and $666 higher following an appendectomy (p = 0.09).Conclusion: Morbid obesity is associated with a higher rate of complications for two commonly performed general surgical procedures and is associated with higher costs for cholecystectomy. Pay-for-performance metrics should account for the increased risk of complications and higher cost in this population.


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