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Effect of body mass index on short-term outcomes after colectomy for cancer
QUALITY, OUTCOMES, AND COSTS II: CANCER, ENDOCRINE, VASCULAR mal weight patients, complications occurred more frequently in the morbidly obese (31.8% vs. 20.5%, P⬍0.0001). Normal and obese patients had similar overall complication rates (22.9% vs. 20.5%). Compared to normal weight patients, the morbidly obese had a higher risk of surgical site infection (20.7% vs. 9.0%; OR 2.66, CI 1.91-3.73), dehiscence (3.3% vs. 1.1%; OR 3.51, CI 1.55-7.95), pulmonary embolism (1.3% vs. 0.3%; OR 6.98, CI 1.62-30.06), and renal failure (3.0% vs. 1.5 %; OR 2.75, CI 1.21-6.26) (Table). Pneumonia, urinary tract infection, stroke, cardiac arrest, myocardial infarction, deep venous thrombosis, length of stay, sepsis, and mortality did not differ significantly by BMI.
Treatment options for Graves’ Disease: A costeffectiveness analysis Haejin In MD, MBA, Elizabeth N Pearce MD, MSc, Arthur K G Wong MBA, MSc, David B McAneny MD, FACS, Jennifer E Rosen MD, FACS Boston University Medical Center, Boston, MA INTRODUCTION: First-line treatment for Graves’ disease is generally 18 months of antithyroid medication (ATM). Controversy exists concerning the best next-line treatment for patients who have failed to achieve euthyroidism; options include lifelong ATM, radioactive iodine (RAI) or total thyroidectomy (TT). We hypothesize that TT is more cost-effective than RAI or lifelong ATM for these patients.
Normal BMI 18.524 (nⴝ1072)
METHODS: We performed a cost-effectiveness analysis comparing the different strategies. Treatment efficacy and complication data were derived from a literature review. Costs were examined from a healthcare system perspective using actual Medicare reimbursement to a university hospital. Outcomes were measured in quality-adjusted life years (QALY). Costs and effectiveness were examined at present values; all key variables were subject to sensitivity analysis.
Obese BMI 30-34 (nⴝ607)
Morbid obesity BMI >35 (nⴝ396)
Odds Ratio (95% confidence interval)
Odds Ratio (95% confidence interval)
Odds Ratio (95% confidence interval)
SSI
RESULTS: RAI was the least costly and least effective (expected cost of $23,600 for an effectiveness of 25.1 QALYs). The incremental cost-effectiveness ratio (ICER) for TT was 7,200 gained over RAI but 17,260 for lifelong ATM. TT reflects a gain of 1.33 QALY at an additional cost of $9,590 and is the most cost-effective strategy. Once the cost of TT exceeds $20,000 the ICER of lifelong ATM and TT reverse and lifelong ATM becomes the more cost-effective strategy at $15,700/QALY.
All
1.0 (referent)
1.40 (1.05-1.87)ⴱ
1.10 (0.78-1.56)
2.46 (1.75-3.46)ⴱ
Superficial
1.0 (referent)
1.67 (1.18-2.37)ⴱ
1.13 (0.74-1.71)
2.93 (1.98-4.35)ⴱ
Deep
1.0 (referent)
1.2 (0.47-3.24)
1.71 (0.61-4.83)
4.51 (1.74-11.67)ⴱ
Dehiscence
1.0 (referent)
0.68 (0.28-1.60)
1.12 (0.44-2.82)
2.93 (1.29-6.64)ⴱ
Pulmonary Embolism
1.0 (referent)
4.25 (1.20-15.04)ⴱ
4.12 (1.01-16.74)ⴱ
6.38 (1.48-7.48)ⴱ
Any Adverse event
1.0 (referent)
1.27 (1.02-1.59)ⴱ
1.13 (0.87-1.47)
1.71 (1.29-2.26)ⴱ
Mortality
1.0 (referent)
0.81 (0.44-1.48)
0.84 (0.38-1.84)
1.27 (0.54-2.97)
ⴱP ⬍ 0.05.
CONCLUSIONS: Compared with normal weight patients, the morbidly obese had a higher risk of surgical site infection, dehiscence, pulmonary embolism, and renal failure, but not other complications or mortality. Quality initiatives should focus on these specific complications.
CONCLUSIONS: This is the first formal cost-effectiveness study in the United States of the optimal treatment for patients with Graves disease who fail to achieve euthyroidism after 18 months of ATM. Our findings demonstrate that TT is more cost-effective than RAI or lifelong ATM in these patients; this continues until the cost of TT becomes greater than $20,000.
The impact of obesity on operative outcomes of carotid endarterectomy James M Scanlon MD, Owen Johnson III, MD, Robyn A Macsata MD, FACS, Mark Slidell MD, MPH, Anton N Sidawy MD, MPH, FACS Georgetown University/Washington Hospital Center, Washington, DC
Effect of body mass index on short-term outcomes after colectomy for cancer Ryan P Merkow MD, Karl Y Bilimoria MD, MS, Martin D McCarter MD, FACS, David J Bentrem MD, FACS University of Colorado, Northwestern University, Denver, CO
INTRODUCTION: The objective of this study is to determine the impact of obesity on the 30-day outcomes for patients undergoing carotid endarterectomy (CEA).
INTRODUCTION: Obesity is associated with an increased risk of postoperative complications after colectomy for cancer; however, it is unclear whether specific complications occur more frequently in obese patients. Our objective was to assess the effect of body mass index (BMI) on short-term outcomes after colectomy for cancer.
METHODS: Prospectively collected data from the Veterans’ Affairs National Surgical Quality Improvement Program (NSQIP) from a two-year period (2005-2006) was retrospectively analyzed. Bodymass index (BMI) categories were assigned according to the American Society for Metabolic and Bariatric Surgery. Complications and 30-day mortality were assessed.
METHODS: Using the ACS-NSQIP dataset, patients were identified who underwent colectomy for malignancy at 121 hospitals over a two-year period (2005-2006). Logistic regression models were developed to assess risk-adjusted short-term outcomes by BMI while adjusting for other comorbidities.
RESULTS: 4,481 patients underwent CEA. BMI was normal (18.5-24.9) in 1,372, overweight (25.0-29.9) in 1,871, Class I obese (30.0-34.9) in 894, Class II obese (35.0-39.9) in 270, and Class III obese (ⱖ40) in 74. On univariate analysis, obesity was associated with increased cardiac complications, venous thromboembolic (VTE) events, and 30-day mortality. Cardiac complications were increased at any BMIⱖ30 [odds ratio (OR) 3.9 (95% CI 2.6-6.0),
RESULTS: 3202 patients were identified: 33.4% normal weight (BMI 18.5-24), 35.1% overweight (BMI 25-29), 19.0% obese (BMI 30-35), and 12.4% morbidly obese (BMI⬎35). Compared to nor-
© 2008 by the American College of Surgeons Published by Elsevier Inc.
Overweight BMI 25-29 (nⴝ1127)
ISSN 1072-7515/08/$34.00
S78
Treatment options for Graves’ Disease: A costeffectiveness analysis Haejin In MD, MBA, Elizabeth N Pearce MD, MSc, Arthur K G Wong MBA, MSc, David B McAneny MD, FACS, Jennifer E Rosen MD, FACS Boston University Medical Center, Boston, MA INTRODUCTION: First-line treatment for Graves’ disease is generally 18 months of antithyroid medication (ATM). Controversy exists concerning the best next-line treatment for patients who have failed to achieve euthyroidism; options include lifelong ATM, radioactive iodine (RAI) or total thyroidectomy (TT). We hypothesize that TT is more cost-effective than RAI or lifelong ATM for these patients.
Normal BMI 18.524 (nⴝ1072)
METHODS: We performed a cost-effectiveness analysis comparing the different strategies. Treatment efficacy and complication data were derived from a literature review. Costs were examined from a healthcare system perspective using actual Medicare reimbursement to a university hospital. Outcomes were measured in quality-adjusted life years (QALY). Costs and effectiveness were examined at present values; all key variables were subject to sensitivity analysis.
Obese BMI 30-34 (nⴝ607)
Morbid obesity BMI >35 (nⴝ396)
Odds Ratio (95% confidence interval)
Odds Ratio (95% confidence interval)
Odds Ratio (95% confidence interval)
SSI
RESULTS: RAI was the least costly and least effective (expected cost of $23,600 for an effectiveness of 25.1 QALYs). The incremental cost-effectiveness ratio (ICER) for TT was 7,200 gained over RAI but 17,260 for lifelong ATM. TT reflects a gain of 1.33 QALY at an additional cost of $9,590 and is the most cost-effective strategy. Once the cost of TT exceeds $20,000 the ICER of lifelong ATM and TT reverse and lifelong ATM becomes the more cost-effective strategy at $15,700/QALY.
All
1.0 (referent)
1.40 (1.05-1.87)ⴱ
1.10 (0.78-1.56)
2.46 (1.75-3.46)ⴱ
Superficial
1.0 (referent)
1.67 (1.18-2.37)ⴱ
1.13 (0.74-1.71)
2.93 (1.98-4.35)ⴱ
Deep
1.0 (referent)
1.2 (0.47-3.24)
1.71 (0.61-4.83)
4.51 (1.74-11.67)ⴱ
Dehiscence
1.0 (referent)
0.68 (0.28-1.60)
1.12 (0.44-2.82)
2.93 (1.29-6.64)ⴱ
Pulmonary Embolism
1.0 (referent)
4.25 (1.20-15.04)ⴱ
4.12 (1.01-16.74)ⴱ
6.38 (1.48-7.48)ⴱ
Any Adverse event
1.0 (referent)
1.27 (1.02-1.59)ⴱ
1.13 (0.87-1.47)
1.71 (1.29-2.26)ⴱ
Mortality
1.0 (referent)
0.81 (0.44-1.48)
0.84 (0.38-1.84)
1.27 (0.54-2.97)
ⴱP ⬍ 0.05.
CONCLUSIONS: Compared with normal weight patients, the morbidly obese had a higher risk of surgical site infection, dehiscence, pulmonary embolism, and renal failure, but not other complications or mortality. Quality initiatives should focus on these specific complications.
CONCLUSIONS: This is the first formal cost-effectiveness study in the United States of the optimal treatment for patients with Graves disease who fail to achieve euthyroidism after 18 months of ATM. Our findings demonstrate that TT is more cost-effective than RAI or lifelong ATM in these patients; this continues until the cost of TT becomes greater than $20,000.
The impact of obesity on operative outcomes of carotid endarterectomy James M Scanlon MD, Owen Johnson III, MD, Robyn A Macsata MD, FACS, Mark Slidell MD, MPH, Anton N Sidawy MD, MPH, FACS Georgetown University/Washington Hospital Center, Washington, DC
Effect of body mass index on short-term outcomes after colectomy for cancer Ryan P Merkow MD, Karl Y Bilimoria MD, MS, Martin D McCarter MD, FACS, David J Bentrem MD, FACS University of Colorado, Northwestern University, Denver, CO
INTRODUCTION: The objective of this study is to determine the impact of obesity on the 30-day outcomes for patients undergoing carotid endarterectomy (CEA).
INTRODUCTION: Obesity is associated with an increased risk of postoperative complications after colectomy for cancer; however, it is unclear whether specific complications occur more frequently in obese patients. Our objective was to assess the effect of body mass index (BMI) on short-term outcomes after colectomy for cancer.
METHODS: Prospectively collected data from the Veterans’ Affairs National Surgical Quality Improvement Program (NSQIP) from a two-year period (2005-2006) was retrospectively analyzed. Bodymass index (BMI) categories were assigned according to the American Society for Metabolic and Bariatric Surgery. Complications and 30-day mortality were assessed.
METHODS: Using the ACS-NSQIP dataset, patients were identified who underwent colectomy for malignancy at 121 hospitals over a two-year period (2005-2006). Logistic regression models were developed to assess risk-adjusted short-term outcomes by BMI while adjusting for other comorbidities.
RESULTS: 4,481 patients underwent CEA. BMI was normal (18.5-24.9) in 1,372, overweight (25.0-29.9) in 1,871, Class I obese (30.0-34.9) in 894, Class II obese (35.0-39.9) in 270, and Class III obese (ⱖ40) in 74. On univariate analysis, obesity was associated with increased cardiac complications, venous thromboembolic (VTE) events, and 30-day mortality. Cardiac complications were increased at any BMIⱖ30 [odds ratio (OR) 3.9 (95% CI 2.6-6.0),
RESULTS: 3202 patients were identified: 33.4% normal weight (BMI 18.5-24), 35.1% overweight (BMI 25-29), 19.0% obese (BMI 30-35), and 12.4% morbidly obese (BMI⬎35). Compared to nor-
© 2008 by the American College of Surgeons Published by Elsevier Inc.
Overweight BMI 25-29 (nⴝ1127)
ISSN 1072-7515/08/$34.00
S78