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Obesity Is Associated with Increased Health Care Charges in Patients Undergoing Outpatient Plastic Surgery

Sieffert, Michelle R. M.D., M.B.A.; Fox, Justin P. M.D., M.H.S.; Abbott, Lindsay E. M.D.; Johnson, R. Michael M.D.

Plastic and Reconstructive Surgery: May 2015 - Volume 135 - Issue 5 - p 1396–1404
doi: 10.1097/PRS.0000000000001155
Cosmetic: Special Topics
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Background: Obesity is associated with greater rates of surgical complications. To address these complications after outpatient plastic surgery, obese patients may seek care in the emergency department and potentially require admission to the hospital, which could result in greater health care charges. The purpose of this study was to determine the relationship of obesity, postdischarge hospital-based acute care, and hospital charges within 30 days of outpatient plastic surgery.

Methods: From state ambulatory surgery center databases in four states, all discharges for adult patients who underwent liposuction, abdominoplasty, breast reduction, and blepharoplasty were identified. Patients were grouped by the presence or absence of obesity. Multivariable regression models were used to compare the frequency of hospital-based acute care, serious adverse events, and hospital charges within 30 days between groups while controlling for confounding variables.

Results: The final sample included 47,741 discharges, with 2052 of these discharges (4.3 percent) being obese. Obese patients more frequently had a hospital-based acute care encounter [7.3 percent versus 3.9 percent; adjusted OR, 1.35 (95% CI,1.13 to 1.61)] or serious adverse event [3.2 percent versus 0.9 percent; adjusted OR, 1.73 (95% CI, 1.30 to 2.29)] within 30 days of surgery. Obese patients had adjusted hospital charges that were, on average, $3917, $7412, and $7059 greater (p < 0.01) than those of nonobese patients after liposuction, abdominoplasty, and breast reduction, respectively.

Conclusion: Obese patients who undergo common outpatient plastic surgery procedures incur substantially greater health care charges, in part attributable to more frequent adverse events and hospital-based health care within 30 days of surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Supplemental Digital Content is available in the text.Video Discussion by John G. Hunter, M.D., is available online for this article.

Dayton, Ohio; and Philadelphia, Pa.

From the Division of Plastic Surgery, Department of Orthopedics Boonshoft School of Medicine, Wright State University; and the Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania.

Received for publication July 30, 2014; accepted October 21, 2014.

Disclosure: The authors have no commercial associations or financial disclosures to report.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (www.PRSJournal.com).

A Video Discussion by John Hunter, M.D., accompanies this article. Go to PRSJournal.com and click on “Video Discussions” in the “Videos” tab to watch.

Michelle R. Sieffert, M.D., M.B.A., Division of Plastic Surgery, 30 East Apple Street, Suite 2200, Dayton, Ohio 45409, mrsieffert@gmail.com

©2015American Society of Plastic Surgeons