Obese patients much more likely to have post-surgical complications (6/30)
Financial incentives for surgeons to choose healthier patients
In the study, Makary and his colleagues examined insurance claims data from seven Blue Cross and Blue Shield plans and identified patients who underwent elective breast procedures covered by insurance between 2002 and 2006. There were 2,403 patients in the obese group and 5,597 patients in the normal weight control group. The most common procedure, by far, was breast reduction, followed by breast reconstruction, augmentation and mastopexy (breast lift). Within 30 days of surgery, 18.3 percent of the obese group experienced at least once complication, compared to 2.2 percent of patients in the control group. The differences between the two groups were most pronounced in complications, such as inflammation (with obese patients 22 times more likely to suffer a complication), infection (13 times) and pain (11 times).
Makary says he fears some surgeons avoid taking obese patients because “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.”
“There are definitely incentives there for surgeons and institutions to select healthier patients,” he adds. “They’re getting reimbursed less per unit of work for obese patients.”
Makary says he hopes more research will be done on the role of obesity in surgical complications covering a wider variety of surgeries and that new metrics can be developed to account for any differences due to obesity.