Sieffert Michelle R, Fox Justin P, Abbott Lindsay E, Johnson R Michael
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.
Plast Reconstr Surg. 2015 May;135(5):1396-1404. doi: 10.1097/PRS.0000000000001155.
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.
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.
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.
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.
肥胖与手术并发症发生率较高相关。为处理门诊整形手术后的这些并发症，肥胖患者可能会前往急诊科就诊，甚至可能需要住院治疗，这可能会导致更高的医疗费用。本研究的目的是确定肥胖、出院后基于医院的急性护理以及门诊整形手术后30天内的医院费用之间的关系。
从四个州的州门诊手术中心数据库中，识别出所有接受抽脂、腹部整形、乳房缩小和眼睑整形的成年患者的出院病例。患者按是否肥胖进行分组。使用多变量回归模型比较两组在30天内基于医院的急性护理频率、严重不良事件和医院费用，同时控制混杂变量。
最终样本包括47741例出院病例，其中2052例（4.3%）为肥胖患者。肥胖患者在手术后30天内更频繁地遭遇基于医院的急性护理[7.3%对3.9%；调整后的比值比，1.35（95%可信区间，1.13至1.61）]或严重不良事件[3.2%对0.9%；调整后的比值比，1.73（95%可信区间，1.30至2.29）]。抽脂、腹部整形和乳房缩小术后，肥胖患者调整后的医院费用分别比非肥胖患者平均高出3917美元、7412美元和7059美元（p<0.01）。
接受常见门诊整形手术的肥胖患者产生的医疗费用大幅更高，部分原因是手术30天内不良事件和基于医院的医疗护理更频繁。
临床问题/证据水平：风险，II级。
