Obese patients undergoing plastic surgery, such as breast augmentation,… (Al Seib / Los Angeles Times )
Obese patients who undergo plastic surgery are 12 times as likely to develop complications as those of normal weight, researchers from the Johns Hopkins University School of Medicine reported Thursday.
Such complications are bad for the patient, but they may also reflect poorly on the surgeons performing the procedures and the hospitals where they are carried out if rating agencies do not take patient weight into consideration, the researchers reported in the journal Plastic and Reconstructive Surgery. Health authorities and insurers are increasingly rating surgeons and penalizing those with higher patient-infection rates and those whose patients are readmitted to the hospital more often.
Dr. Marty Makary, the lead author of the paper, said he fears that some surgeons are already avoiding taking on obese patients because their surgeries take longer to perform, have a higher risk of complications, and may affect the doctors' performance ratings.
About 34% of U.S. adults are now thought to be obese -- with a body mass index, or BMI, of 30 or higher -- up from just 15% a decade ago, the authors said. Meanwhile, the volume of plastic surgery has increased 725% between 1992 and 2005.
Performing surgery on the obese presents a special set of problems, said Makary, a surgeon himself. The surgeries take longer, the operating fields are deeper, the spaces in which an infection can take root are typically greater, and blood flow in fat tissue is less than in other tissues, impairing healing. Yet Medicare and insurance companies pay the same for every surgical procedure, regardless of the size of the patient.
Makary and his colleagues examined insurance claims data from seven Blue Cross and Blue Shield plans for patients who underwent elective breast surgery procedures between 2002 and 2006. They identified 2,403 patients in the obese group and 5,597 patients with normal weight. The most common procedure was breast reduction, followed by reconstruction, augmentation and mastoplexy (breast lift).
Within 30 days after the surgery, 18.3% of the obese group had experienced at least one complication, compared with 2.2% of the normal-weight group. Inflammation was 22 times as likely in the obese group, infections were 13 times as likely and pain was 11 times as common.
"There are definite incentives there for surgeons and institutions to select healthier patients," Makary said in a statement. "They're getting reimbursed less per unit of work for obese patients."
Markary said further research is needed to determine if a high complication rate is common for other types of surgeries as well.