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05-07-2011 | Gastroenterology | Article

Obesity is major risk factor for post-colectomy infection

Abstract

Free abstract

MedWire News: The risk for surgical-site infections following colectomy is 60% higher in obese as compared with nonobese individuals, a team at Johns Hopkins University (Baltimore, Maryland, USA) has shown.

The group estimates that the cost of treating these infections is far in excess of US$17,000 (€11,912) per patient and conclude that obese individuals "tax the healthcare system."

The researchers, led by Elizabeth Wick, undertook a retrospective cohort study of 7020 patients undergoing colectomy between 2002 and 2008; indications for surgery included colon cancer, diverticulitis, and inflammatory bowel disease.

In all, 1243 patients were classified as obese at the time of surgery, based on a body mass index greater than or equal to 30 kg/m2.

The rate of surgical-site infections at 30 days was significantly higher in obese than in non-obese patients, at 14.5 versus 9.5%. Indeed, on multivariate analysis, obesity was the strongest predictor for postoperative infection, with an odds ratio of 1.59.

The mean cost of colectomy was $16,399 (€11,491) per person, with the cost being around $300 (€210) higher in obese versus nonobese individuals irrespective of whether they developed an infection.

In all, 10.3% of the cohort developed postoperative surgical-site infections, at an average additional cost of $17,324 (€12,142) per person. The extra cost associated with infection was driven by longer durations of hospital stay (9.5 vs 8.1 days) and higher rates of hospital readmission (27.8 vs 6.8%).

Discussing their findings, Wick et al note that surgical-site infections are "increasingly the target of governmental and private efforts to improve quality in surgical care." Indeed, it has been proposed that payment should be withheld from hospitals and surgeons in cases where a patient develops such an infection.

With this in mind, the researchers warn that such policies risk unfairly penalizing hospitals and providers who disproportionately care for obese and other high-risk patients. It could also be perceived as discriminatory, given that obesity is substantially higher in certain minority groups such as Black women.

"We conclude that patients undergoing colorectal surgery who develop SSIs, many of whom are obese, tax the healthcare system. Pay-for-performance policies in surgery should account for the increased risk of infection and cost of caring for this population," write Wick and co-authors in the journal Archives of Surgery.

"Failure to consider these differences could lead to perverse incentives that may penalize surgeons who care for obese patients and may even affect obese patients' access to colorectal surgery."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Joanna Lyford

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