Obesity is associated with increased health care charges in patients undergoing outpatient plastic surgery.

BACKGROUND: Obesity is associated with greater rates of surgical complications. To address these complications after outpatient plastic surgery, obese patients may seek care in the emergency department and potentially require admission to the hospital, which could result in greater health care charges. The purpose of this study was to determine the relationship of obesity, postdischarge hospital-based acute care, and hospital charges within 30 days of outpatient plastic surgery. METHODS: From state ambulatory surgery center databases in four states, all discharges for adult patients who underwent liposuction, abdominoplasty, breast reduction, and blepharoplasty were identified. Patients were grouped by the presence or absence of obesity. Multivariable regression models were used to compare the frequency of hospital-based acute care, serious adverse events, and hospital charges within 30 days between groups while controlling for confounding variables. RESULTS: The final sample included 47,741 discharges, with 2052 of these discharges (4.3 percent) being obese. Obese patients more frequently had a hospital-based acute care encounter [7.3 percent versus 3.9 percent; adjusted OR, 1.35 (95% CI,1.13 to 1.61)] or serious adverse event [3.2 percent versus 0.9 percent; adjusted OR, 1.73 (95% CI, 1.30 to 2.29)] within 30 days of surgery. Obese patients had adjusted hospital charges that were, on average, $3917, $7412, and $7059 greater (p < 0.01) than those of nonobese patients after liposuction, abdominoplasty, and breast reduction, respectively. CONCLUSION: Obese patients who undergo common outpatient plastic surgery procedures incur substantially greater health care charges, in part attributable to more frequent adverse events and hospital-based health care within 30 days of surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Variation in hospital-based acute care within 30 days of outpatient plastic surgery.

BACKGROUND: When complications arise following outpatient plastic surgery, patients may require hospital-based acute care after discharge. The extent to which these events vary across centers may reflect the quality of care provided. The authors conducted this study to describe the frequency and variation of hospital-based acute care rates across ambulatory surgery centers. METHODS: From the 2009 to 2010 California, Florida, Nebraska, and New York ambulatory surgery databases, the authors identified adult patients who underwent common outpatient plastic surgery procedures between July of 2009 and September of 2010. Hospital-based acute care was defined as any emergency department visit or hospital admission within 30 days of discharge. Performance across centers was assessed by calculating observed-to-expected ratios derived from multivariable logistic regression models. RESULTS: The authors identified 72,308 discharges from 519 centers. Most were female patients (80.9 percent); self-pay patients (41.5 percent); and underwent blepharoplasty (36.9 percent), breast augmentation (14.2 percent), or multiple procedures (12.2 percent). The observed hospital-based, acute care rate was 42.8 encounters per 1000 discharges, with most managed in the emergency department for symptoms or complications of care. The median charges associated with these encounters were $2183 and $26,299 for emergency department visits and hospital admissions, respectively. Wide variation was noted in hospital-based acute care rates, with 15 centers (2.9 percent) performing significantly better and 27 (5.2 percent) performing significantly worse than expected after adjusting for case mix. CONCLUSIONS: The overall rate of hospital-based acute care after common outpatient plastic surgery procedures is low but measurable. However, the frequency of these events varies across centers and may reflect the quality of care provided.