Obesity Linked to Increased Health Care Costs after Plastic Surgery

After common plastic surgery procedures, obese patients have more complications and make more hospital visits-leading to higher healthcare costs, reports a study in the May issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Even after accounting for their higher rate of other medical conditions, "Overweight and obese patients remained 35 percent more likely to have an emergency department visit or hospital admission within 30 days of surgery," report Michelle R. Sieffert, MD, MBA, of Wright State University in Dayton, Ohio, and colleagues.

Higher Risks and Costs after Plastic Surgery in Obese Patients

Using ambulatory surgery databases from four states, the researchers identified nearly 48,000 adult patients undergoing common cosmetic plastic surgery procedures: liposuction, abdominoplasty ("tummy tuck"), breast reduction, or blepharoplasty (eyelid surgery).

About four percent of the patients were classified as obese, based on body mass index. The obese patients had higher rates of other types of "comorbid" medical conditions, including diabetes, high blood pressure, cardiovascular disease, and mental health problems.

Within 30 days after surgery, 7.3 percent of obese patients made an emergency department visit or were admitted to the hospital, compared to 3.9 percent of nonobese patients. After adjustment for comorbid conditions and other factors, relative risk was 35 percent higher for obese patients.

Obesity was also associated with a higher risk of serious adverse events within 30 days after plastic surgery: 3.2 percent versus 0.9 percent. After adjustment, relative risk was 72 percent higher for the obese patients.

These increased risks led to higher hospital charges for obese patients, with average cost differences of about $3,900 after liposuction, $7,100 after abdominoplasty, and $7,400 after breast reduction. The rate of hospital visits was highest for obese patients undergoing abdominoplasty who had three or more comorbid conditions.

Many studies have found that obesity is associated with higher rates of surgical complications, including after plastic surgery. The new report links obesity to an increased risk of emergency department visits and hospitalizations, leading to increased healthcare costs, in patients undergoing common types of cosmetic plastic surgery.

The findings may have important implications for informing patients about the risks associated with plastic surgery. Dr. Sieffert and coauthors write, "Throughout the perioperative period, it is important to educate overweight and obese patients regarding their risk of complications, as well as the importance of medical optimization of their comorbid conditions," they write. For example, in diabetic patients, maintaining careful control of blood glucose levels might reduce the risk of complications.

Patients with higher body weight should also be aware that they may incur higher costs of care. "Because most insurance companies will not cover complications associated with elective cosmetic procedures, these additional costs may fall on the patient," Dr. Sieffert and colleagues add.