Background: The increasing prevalence of obesity may worsen surgical outcomes and confound standardized metrics of surgical quality. Despite anecdotal evidence, the increased risk of complications in obese patients is not accounted for in these metrics. To better understand the impact of obesity on surgical complications, the authors designed a study to measure complication rates in obese patients presenting for a set of elective breast procedures.
Methods: Using claims data from seven Blue Cross and Blue Shield plans, the authors identified a cohort of obese patients and a nonobese control group who underwent elective breast procedures covered by insurance between 2002 and 2006. The authors compared the proportion of patients in each group who experienced a surgical complication. Using multivariate logistic regression, the authors calculated the odds of developing a surgical complication when obesity was present.
Results: There were 2403 patients in the obese group (breast reduction, 80.7 percent; reconstruction, 10.3 percent; mastopexy with augmentation, 1.5 percent; mastopexy alone, 3.5 percent; and augmentation alone, 4.0 percent). The occurrence of complications was compared for each procedure to a nonobese control group of 5597 patients. Overall, 18.3 percent of obese patients had a claim for a complication, compared with only 2.2 percent in the control group (p<0.001). Obesity status increased the odds of experiencing a complication by 11.8-fold after adjusting for other variables.
Conclusions: Obesity is associated with a nearly 12-fold increased odds of a postoperative complication after elective breast procedures. As quality measures are increasingly applied to surgical evaluation and reimbursement, appropriate risk adjustment to account for the effect of obesity on outcomes will be essential.
Clinical question/level of evidence: Risk, II.