Department of Surgery, Johns Hopkins University School of Medicine, CRB II, Ste. 507, 1550 Orleans Street, Baltimore, MD 21231, USA.
J Gastrointest Surg. 2011 Jul;15(7):1128-35. doi: 10.1007/s11605-011-1529-3. Epub 2011 May 1.
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.
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.
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).
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.
手术并发症的发生率越来越多地被用于按绩效付费的报销结构。我们假设病态肥胖对常见普通外科手术后的并发症发生率和成本有显著影响。
我们使用七个蓝十字蓝盾计划在 7 年期间（2002-2008 年）的行政索赔数据，研究了 30502 例因胆囊炎而行胆囊切除术和 6390 例因急性阑尾炎而行阑尾切除术的患者。我们比较了肥胖和非肥胖患者的 30 天内并发症以及总 30 天直接医疗费用。进行多元回归分析以确定病态肥胖与并发症和成本的关系。
肥胖患者在手术后 30 天内发生并发症的可能性高于非肥胖患者（胆囊切除术为 19.2%比 15.7%，p<0.0001；阑尾切除术为 20.2%比 15.2%，p<0.0001）。肥胖患者胆囊切除术后 30 天的总术后费用平均高出 1109 美元（p<0.0001），阑尾切除术后高出 666 美元（p=0.09）。
病态肥胖与两种常见普通外科手术的并发症发生率较高有关，并且与胆囊切除术的成本较高有关。按绩效付费的指标应考虑到该人群的并发症风险增加和成本增加。
