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Obesity complicates breast surgery, confounding surgical quality metrics

Kathleen Blanchard's picture
Obesity linked to breast surgery complications

Breast surgery complications twelve times higher for obese women

Researchers suggest obesity should be accounted for when deciding on insurance reimbursement incentives that "pay for performance".

A new study finds obese women have more complications after breast surgery and more medical claims that could skew standardized measures of surgical quality.

Compared to normal weight women, researchers found obesity was associated with a twelve-fold increase in breast surgery complications that include infection, pain, bleeding and post-operative hematoma.

The study, published in the journal Plastic and Reconstructive Surgery, highlights the role of inflammation related to obesity.

Dr. Catherine Lee Chen and colleagues of The Johns Hopkins University School of Medicine, Baltimore conducted the analysis by reviewing medical claims.

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Approximately 18 percent of obese women filed an insurance claim covering a complication after breast surgery, compared to two percent of non-obese women.

Most of the women in the study were undergoing breast reduction surgery. The study included 8,000 women undergoing elective breast surgery between 2002 and 2006; 30 percent were obese.

The authors write, “While the effect of obesity on disease has been established, its impact on short-term surgical outcomes has not been quantified.”

The finding suggests obesity should be factored into quality measures that relate to “pay for performance” insurance plans.

The authors say, “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.”

Even when other risks were factored in, the study found obese women were 12 times more likely to experience complications of breast surgery.

Plastic and Reconstructive Surgery: doi: 10.1097/PRS.0b013e3182284c05
"The Impact of Obesity on Breast Surgery Complications"
Catherine L. Chen et al.
November, 2011