Obesity May Increase Risk of Surgical Complications

FRIDAY July 8, 2011 -- Obese people who have elective surgery are nearly 12 times more likely to suffer from complications than those of normal weight, new research indicates.

Since data on surgical outcomes are often used by insurance companies, the Johns Hopkins researchers argued that the findings should change how doctors and hospitals are reimbursed for more complex procedures or penalized for higher complication rates.

Operations on obese patients are more demanding because they take longer and the operating fields are deeper, study leader Dr. Marty Makary, an associate professor of surgery, explained in a Hopkins news release. Obese patients who undergo surgery are also at greater risk for surgical site infection and slower healing because of reduced blood flow in fat tissue, Makary noted. Despite these added risks, Makary noted, "payments are based on the complexity of the procedure and are not adjusted for the complexity of the patient."

The study is published online in the journal Plastic and Reconstructive Surgery.

In conducting the study, researchers examined insurance claims, identifying 2,403 obese patients and 5,597 normal weight patients who underwent elective breast procedures, such as breast lifts, reductions and augmentations, between 2002 and 2006.

Within 30 days of surgery, 18.3 percent of the obese group experienced at least one complication, compared to 2.2 percent of non-obese patients. More specifically, obese patients were 22 times more likely to have inflammation, 13 times more likely to develop infection and 11 times more likely to experience pain.

The findings are significant, given that 34 percent of adults in the United States are estimated to be obese -- up from just 15 percent a decade ago. Meanwhile, the number of people having elective plastic surgery is also on the rise. Annual plastic surgery volume increased 725 percent between 1992 and 2005. Despite the trend, the study's authors concluded the increased risk of complications could deter some surgeons from taking on these higher-risk obese patients.

"It's more work, and it's a more complex surgery, as opposed to operating on a thin patient. And the payment is the same," Makary pointed out. "There are definitely incentives there for surgeons and institutions to select healthier patients. They're getting reimbursed less per unit of work for obese patients."

The researchers concluded that more research is needed to determine the role obesity plays in a wider range of surgeries so that new standards can be established to account for any differences, particularly increased risks.

More information

The American Heart Association details some of the cardiac risks associated with surgery in obese patients.

Posted: July 2011


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