H. Hanif1, F. Agullo1,2, T. Yeager1, G. Coleman1, I. Mallawaarachchi1, A. Nassiri1, V. Molinar1, A. Molinar2, A. Tyroch1, H. Palladino1,2 1Texas Tech University Health Sciences Center,Surgery And Biomedical Sciences,El Paso, TEXAS, USA 2Southwest Plastic Surgery,El Paso, TEXAS, USA
Introduction: Obesity has been the main focus of many public health efforts in the United States. It is a global epidemic with approximately 33% of adults being obese. Obesity both directly and indirectly leads to increases in health care expenditures and resources. Increased consumption of surgical services by obese patients compared to their non-obese counterparts for routine general surgery procedures has been analyzed. Our aim was to investigate the relationship between Body Mass Index (BMI) and the time required to complete standard tasks in the operating room during elective cholecystectomy and to identify the financial impact.
Methods: Our study investigated operative time differences in different BMI groups. Comparisons of continuous variables according to dichotomized BMI were done using a two group t-test or Wilcoxon rank-sum test, while one way analysis of variance or Kruskal Wallis test was used to compare continuous variables according to multi categorical BMI. Linear regression models were developed for all three outcome variables (operating room, anesthesia and surgery times) using multi-category BMI as the main exposure adjusted for age, gender, ethnicity, number of comorbidities, airway type and smoking history.
Results: We included 2068 patients in our study, 1037 patients with BMI<30 and 1025 patients with BMI≥30. The data was further classified according to the WHO obesity classification. The average operating room, anesthesia and surgery times (in minutes) for BMI<25 were 114.4, 124.6, 81.3 respectively and for BMI≥40 were 134.3, 140.5, 96.2. The times of all three outcome variables were significantly different between the two groups with P-values < 0.001. BMI, age, gender and ethnicity continued to be significant in all the final models. When age, gender and ethnicity were adjusted for in our final model, the coefficients for BMI≥40 category compared to BMI<25 category for operating room, anesthesia and surgery times were 22.0 (P-value<0.001), 18.2 (P-value<0.001) and 16.7 (P-value<0.001) respectively (Table 1).
Conclusion: As shown by our data there is significant increase in operative room, anesthesia and surgery times in patients with higher BMI which in turn leads to greater perioperative resource usage and increased hospital cost. We propose a change in CPT coding to compensate for the increased utilization of resources.
