Background: The increasing prevalence of obesity may worsen surgical outcomes and confound standardized metrics of surgical quality. Despite anecdotal evidence, the increased risk of complications in obese patients is not accounted for in these metrics. To better understand the impact of obesity on surgical complications, the authors designed a study to measure complication rates in obese patients presenting for a set of elective breast procedures.
Methods: Using claims data from seven Blue Cross and Blue Shield plans, the authors identified a cohort of obese patients and a nonobese control group who underwent elective breast procedures covered by insurance between 2002 and 2006. The authors compared the proportion of patients in each group who experienced a surgical complication. Using multivariate logistic regression, the authors calculated the odds of developing a surgical complication when obesity was present.
Results: There were 2403 patients in the obese group (breast reduction, 80.7 percent; reconstruction, 10.3 percent; mastopexy with augmentation, 1.5 percent; mastopexy alone, 3.5 percent; and augmentation alone, 4.0 percent). The occurrence of complications was compared for each procedure to a nonobese control group of 5597 patients. Overall, 18.3 percent of obese patients had a claim for a complication, compared with only 2.2 percent in the control group (p < 0.001). Obesity status increased the odds of experiencing a complication by 11.8-fold after adjusting for other variables.
Conclusions: Obesity is associated with a nearly 12-fold increased odds of a postoperative complication after elective breast procedures. As quality measures are increasingly applied to surgical evaluation and reimbursement, appropriate risk adjustment to account for the effect of obesity on outcomes will be essential.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
From the Departments of Surgery and Medicine, The Johns Hopkins University School of Medicine, and the Departments of Health Policy and Management and Epidemiology, The Johns Hopkins School of Public Health.
Received for publication October 24, 2010; accepted April 14, 2011.
Disclosure: This research was funded by The Mr. and Mrs. Chad and Nissa Richison Foundation. The data set used in this current study was originally created for a study of patterns of obesity care within selected Blue Cross and Blue Shield plans. The previous study (but not the current study) was funded by unrestricted research grants from Ethicon Endo-Surgery, Inc. (a Johnson & Johnson company); Pfizer, Inc.; and GlaxoSmithKline. The data and database development support and guidance were provided by the Blue Cross and Blue Shield Association, Blue Cross and Blue Shield of Tennessee, Blue Cross and Blue Shield of Hawaii, Blue Cross and Blue Shield of Michigan, Blue Cross and Blue Shield of North Carolina, Highmark, Inc. (of Pennsylvania), Independence Blue Cross (of Pennsylvania), Wellmark Blue Cross and Blue Shield of Iowa, and Wellmark Blue Cross and Blue Shield of South Dakota. All investigators take responsibility for the integrity of the data and the accuracy of the data analysis. All listed authors contributed to the design, analysis, or writing of this study, and none has conflicts of interest. The authors of this article are responsible for its content.
Martin A. Makary, M.D., M.P.H.; The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, CRB II, Suite 507, 1550 Orleans Street, Baltimore, Md. 21231, firstname.lastname@example.org