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

J Gastrointest Surg. 2011 Jul;15(7):1128-35. doi: 10.1007/s11605-011-1529-3. Epub 2011 May 1.

Abstract

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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bariatric Surgery / adverse effects
  • Bariatric Surgery / economics*
  • Body Mass Index
  • Cost of Illness*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Obesity / economics*
  • Obesity / surgery
  • Postoperative Complications / economics*
  • Reimbursement, Incentive / economics*
  • Retrospective Studies
  • Treatment Outcome
  • United States
  • Young Adult