Length of hospital stays among obese individuals

Predictors of length of hospital stay after total hip replacement

PURPOSE

To identify variables affecting length of hospital stay after total hip replacement (THR) while controlling for potential confounders.

METHODS

Records of 199 consecutive elective unilateral THRs were reviewed. Clinical and demographic data including age, gender, body mass index, comorbidities, surgical factors (surgical approach, type of prosthesis, use of cement, operating time), anaesthetic factors (type of anaesthesia, ASA physical status), and length of hospital stay were recorded.

RESULTS

64% of patients left hospital within 12 days, 28% within 3 weeks, and 8% after 3 weeks. The median length of hospital stay was longer in women than men (11.5 vs. 9 days, p=0.009), in patients aged >65 years than those younger (13 vs. 9 days, p<0.0001), and in those with American Society of Anesthesiologists (ASA) grades 3 and 4 than grades 1 or 2 (14 vs. 9 days, p<0.0001). A greater proportion of women than men (45% vs. 27%, p=0.007), patients aged >65 years than those younger (61% vs. 37% or 24%, p<0.0001), and those with ASA grades 3 and 4 than grades 1 and 2 (68% vs. 25%, p<0.0001) stayed 12 days or longer. In the multiple regression analysis, the predictors for prolonged hospital stay (12 days or more) were patient age >65 years (p<0.003), female gender (p<0.05), and ASA grades 3 and 4 (p<0.0001). Of the 72 patients with prolonged stay, 7% had no, 26% had one, 42% had 2, and 25% had all 3 predictors.

CONCLUSION

Prolonged hospital stay after THR is largely predetermined by case mix. Our study helps to identify individuals who need longer rehabilitation and more care.

Obesity predicts primary health care visits: a cohort study

The objective of this study was to explore the relationship between body mass index (BMI), its association with chronic disease, and its impact on health services utilization in the province of Newfoundland and Labrador, Canada, from 1998 to 2002. A data linkage study was conducted involving a provincial health survey linked to 2 health care use administrative databases. The study population comprised 2345 adults between the ages of 20 and 64 years. Self-reported height and weight measures and other covariates, including chronic diseases, were obtained from a provincial survey. BMI categories include: normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), obese class I (BMI 30-34.9), obese class II (BMI ≥ 35), and obese class III (BMI ≥ 40). Survey responses were linked with objective physician and hospital health services utilization over a 5-year period. Weight classifications in the study sample were as follows: 37% normal, 39% overweight, 17% obese, and 6% morbidly obese. The obese and morbidly obese were more likely to report having serious chronic conditions after adjusting for age and sex. Only the morbidly obese group (BMI ≥ 35 kg/m(2)) had a significantly higher number of visits to a general practitioner (GP) over a 5-year period compared to the normal weight group (median 22.0 vs. 17.0, P<0.05). Using multivariate models and controlling for the number of chronic conditions and other relevant covariates, being morbidly obese remained a significant predictor of GP visits (P<0.001), but was not a predictor for visits to a specialist or any type of hospital use. The increase in the prevalence of obesity is placing a burden at the primary health care level. More resources are needed in order to support GPs in their efforts to manage and treat obese adults who have associated comorbidities.

Providing nutrition to critically ill obese adults: use of the nursing process

Caring for obese critically ill patients is not always the same as caring for critically ill patients who are not obese. Fortunately, nurses have many resources available to them to guide them in this process. However, research that specifically addresses the needs of obese critically ill patients is still lacking in many areas and should be considered as potential areas to develop evidence-based practices.

Determinants of outcomes in pancreatic surgery and use of hospital resources

BACKGROUND AND OBJECTIVES

Outcomes for patients undergoing major pancreatic surgery have improved, but a subset of patients that significantly utilize more resources exists. Variables that can lead to an increase in resource utilization in patients undergoing pancreatic surgery were identified.

METHODS

Patients undergoing pancreatic surgery for neoplasms were identified from the NSQIP database (2006-2008). Indices associated with increased resource utilization that we included were operative time (OT), length of stay (LOS), intraoperative RBC transfusion, return to operating room, and occurrence of postoperative complications. Analysis of covariance and multivariable logistic regression were performed.

RESULTS

The 4,306 included patients had a median age of 66 years and 50.3% were males. The 30-day morbidity and mortality were 29.3% and 3.2%, respectively. Median OT was 362  min and median LOS was 10 days. Malignancy, neoadjuvant radiation, and medical co-morbidities were associated with increased OT (P < 0.0001 for all). Declining preoperative functional status was the most important predictor of LOS (P < 0.0001). Age, male gender, hypertension, severe COPD, and higher BMI were significantly associated with postoperative complications (P < 0.050 for all).

CONCLUSIONS

Morbidity after pancreatic surgery remains high. Age, obesity, performance status, medical co-morbidities, and neoadjuvant radiation affect outcomes and may lead to increased use of hospital resources.

Health-care expenditures of overweight and obese males and females in the medical expenditures panel survey by age cohort

Age- and sex-specific annual health-care expenditures (total, in-patient, ambulatory care, and outpatient prescription drug) were estimated within established weight classifications in a nationally representative sample of children and adults aged 6-85 years (n = 80,516) in the Medical Expenditures Panel Survey (MEPS). The expenditures were estimated with two-part regression models and standard errors accounted for the complex survey design. Compared to their normal-weight counterparts, total expenditures were higher for overweight females between age 22 ($85; 95% CI: $1, $166) and age 77 ($623; 95% CI: $14, $1,259); overweight males between age 48 ($168; 95% CI: $9, $312) and age 67 ($612; 95%: $31, $1,139); obese females between age 21 ($88; 95% CI: $12, $207) and age 82 ($1,497; 95% CI: $212, $2,592); and obese males between age 25 ($88; 95% CI: $9, $158) and age 83 ($3,236; 95% CI: $378, $6,637). Differences were primarily due to higher ambulatory care and prescription drug expenditures and, for women only, higher in-patient expenditures. Overweight- and obesity-associated health-care expenditures are substantial and emerge at younger ages for women than for men. Expenditures associated with obesity exceed those associated with overweight. Further research is required to elucidate factors underlying the differences by sex.

Body mass index and the impact on hospital resource use in patients undergoing total knee arthroplasty

We identified all total knee arthroplasty patients between 1996 and 2004 and classified them by preoperative body mass index (BMI) as normal (BMI, 18.5-24.9 kg/m(2)), overweight (BMI, 25.0-29.9 kg/m(2)), obese (30-34.9 kg/m(2)), or morbidly obese (≥ 35.0 kg/m(2)). Of 5521 patients, 769 had a normal BMI, 1938 were overweight, 1539 were obese, and 1275 were morbidly obese. Adjusted length of stay was no different between normal (4.85 days), overweight (4.84 days), obese (4.86 days), or morbidly obese patients (4.93 days) (P = .30). Overall costs were similar among normal ($15,386), overweight ($15,430), obese ($15,646), or morbidly obese patients ($15,752) (P = .24). Postsurgical costs were no different among normal ($9860), overweight ($9889), obese ($10,063), or morbidly obese patients ($10,136) (P = .44). Our results suggest that increased BMI does not lead to increased hospital resource use for total knee arthroplasty.

Variations and determinants of hospital costs for acute stroke in China

Background

The burden of stroke is high and increasing in China. We modelled variations in, and predictors of, the costs of hospital care for patients with acute stroke in China.

Methods and Findings

Baseline characteristics and hospital costs for 5,255 patients were collected using the prospective register-based ChinaQUEST study, conducted in 48 Level 3 and 14 Level 2 hospitals in China during 2006–2007. Ordinary least squares estimation was used to determine factors associated with hospital costs. Overall mean cost of hospitalisation was 11,216 Chinese Yuan Renminbi (CNY) (≈US$1,602) per patient, which equates to more than half the average annual wage in China. Variations in cost were largely attributable to stroke severity and length of hospital stay (LOS). Model forecasts showed that reducing LOS from the mean of 20 days for Level 3 and 18 days for Level 2 hospitals to a duration of 1 week, which is common among Western countries, afforded cost reductions of 49% and 19%, respectively. Other lesser determinants varied by hospital level: in Level 3 hospitals, health insurance and the occurrence of in-hospital complications were each associated with 10% and 18% increases in cost, respectively, whilst treatment in a teaching hospital was associated with approximately 39% decrease in cost on average. For Level 2 hospitals, stroke due to intracerebral haemorrhage was associated with a 19% greater cost than for ischaemic stroke.

Conclusions

Changes to hospital policies to standardise resource use and reduce the variation in LOS could attenuate costs and improve efficiencies for acute stroke management in China. The success of these strategies will be enhanced by broader policy initiatives currently underway to reform hospital reimbursement systems.

Medical services utilization and expenditure of obesity-related disorders in Taiwanese adults

OBJECTIVES

To evaluate medical service utilization and medical expenditure associated with obesity-related diseases among different weight status subjects in Taiwan.

METHODS

A cross-sectional survey based on the National Health Interview Survey performed in 2001. Subjects greater than 20 years old who lived in Taiwan, as corroborated by National Health Insurance (NHI), during 2001, were included. Overall, the data set included 15,461 subjects with age of 20-85 years old. After excluding those subjects with incomplete or missing data or who refused to link their data with the NHI data, 12,283 subjects were used for analyses.

RESULTS

In general, obesity-related disorders, such as hypertension, diabetes mellitus (DM), and cardiovascular diseases have increasing prevalence with greater body mass index (BMI; P<0.001). Obese subjects (BMI≧27kg/m(2) ) had the highest prevalence of hypertension (31.9%), after DM (26.9%). After adjusting for age, smoking, drinking and obesity-related disorders, it was found that medical utilization in outpatient increases from 1.33 to 4.04 visits/year (P<0.001) and in-hospital increases from 0.05 to 0.07 admissions/year (P>0.05) with higher BMI. Average outpatient expenditure (including physician fee, laboratory test and drug costs) per year is NT$1201, 1857, 3960, and 5118 (at an exchange rate of NT$32 to US$1) for underweight, normal, overweight, and obese subjects, respectively (P<0.001).

CONCLUSIONS

Medical utilization and outpatient medical expenditure was found to increase with higher BMI status. However, there was a J-shaped (in female) or even negative (in male) relationship between BMI and in-hospital medical expenditures. Further studies are needed to resolve this major public health problem, even in a developing country such as Taiwan.

Addressing obesity in the hospitalized patient: a needs assessment

OBJECTIVE

To perform a needs assessment to determine the extent to which hospitalist providers recognize and intervene upon obese patients in the hospital setting.

METHODS

A chart review was performed for patients admitted to the hospitalist service at Johns Hopkins Bayview Medical Center between September 1 and October 1, 2008. Patient charts were reviewed for documentation of obesity and treatment plans were ordered and implemented. Demographic data for patients and hospitalist providers was also collected. Providers were also surveyed about their documentation practices related to obesity and any perceived barriers.

RESULTS

Forty-nine percent (136/276) of admitted patients were obese. Obesity was documented in 19% (26/136) of admission notes and a discrete plan was made to address obesity 7% (10/136) of the time. Hospitalist providers were more likely to document obesity in patients <60 years old (85% versus 55% respectively, P <0.007), and in patients with body mass indices (BMI) >or= 35 (77% versus 44% respectively, P < 0.004). Provider survey results suggest that providers do not document obesity because it is not considered to be an acute issue (67%), and they elect not to address obesity because they lack the time (63%), skill (37%), and they believe that their efforts will be unsuccessful (33%).

CONCLUSION

Documentation of obesity by hospitalist providers is poor. Because an inpatient admission has been characterized as a teachable moment when patients are willing to reflect on behavior change, this may be an ideal time to counsel and educate obese patients.

BMI and risk of serious upper body injury following motor vehicle crashes: concordance of real-world and computer-simulated observations

BACKGROUND

Men tend to have more upper body mass and fat than women, a physical characteristic that may predispose them to severe motor vehicle crash (MVC) injuries, particularly in certain body regions. This study examined MVC-related regional body injury and its association with the presence of driver obesity using both real-world data and computer crash simulation.

METHODS AND FINDINGS

Real-world data were from the 2001 to 2005 National Automotive Sampling System Crashworthiness Data System. A total of 10,941 drivers who were aged 18 years or older involved in frontal collision crashes were eligible for the study. Sex-specific logistic regression models were developed to analyze the associations between MVC injury and the presence of driver obesity. In order to confirm the findings from real-world data, computer models of obese subjects were constructed and crash simulations were performed. According to real-world data, obese men had a substantially higher risk of injury, especially serious injury, to the upper body regions including head, face, thorax, and spine than normal weight men (all p<0.05). A U-shaped relation was found between body mass index (BMI) and serious injury in the abdominal region for both men and women (p<0.05 for both BMI and BMI(2)). In the high-BMI range, men were more likely to be seriously injured than were women for all body regions except the extremities and abdominal region (all p<0.05 for interaction between BMI and sex). The findings from the computer simulation were generally consistent with the real-world results in the present study.

CONCLUSIONS

Obese men endured a much higher risk of injury to upper body regions during MVCs. This higher risk may be attributed to differences in body shape, fat distribution, and center of gravity between obese and normal-weight subjects, and between men and women. Please see later in the article for the Editors' Summary.

Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality

AIMS

We hypothesized that subjects with a normal body mass index (BMI), but high body fat (BF) content [normal weight obesity (NWO)], have a higher prevalence of cardiometabolic dysregulation and are at higher risk for cardiovascular (CV) mortality.

METHODS AND RESULTS

We analysed 6171 subjects >20 years of age from the Third National Health and Nutrition Examination Survey (NHANES III) and the NHANES III mortality study, whose BMI was within the normal range (18.5-24.9 kg/m(2)), and who underwent a complete evaluation that included body composition assessment, blood measurements, and assessment of CV risk factors. Survival information was available for >99% of the subjects after a median follow-up of 8.8 years. We divided our sample using sex-specific tertiles of BF%. The highest tertile of BF (>23.1% in men and >33.3% in women) was labelled as NWO. When compared with the low BF group, the prevalence of metabolic syndrome in subjects with NWO was four-fold higher (16.6 vs. 4.8%, P < 0.0001). Subjects with NWO also had higher prevalence of dyslipidaemia, hypertension (men), and CV disease (women). After adjustment, women with NWO showed a significant 2.2-fold increased risk for CV mortality (HR = 2.2; 95% CI, 1.03-4.67) in comparison to the low BF group.

CONCLUSION

Normal weight obesity, defined as the combination of normal BMI and high BF content, is associated with a high prevalence of cardiometabolic dysregulation, metabolic syndrome, and CV risk factors. In women, NWO is independently associated with increased risk for CV mortality.

Impact of body mass on hospital resource use in total hip arthroplasty

Objective

To determine the impact of BMI on post-operative outcomes and resource utilization following elective total hip arthroplasty (THA).

Design

A retrospective cohort analysis on all primary elective THA patients between 1996 and 2004. Primary outcomes investigated using regression analyses included length of stay (LOS) and costs (US dollars).

Setting

Mayo Clinic Rochester, a tertiary care centre.

Subjects

Patients were stratified by pre-operative BMI as normal (18·5–24·9 kg/m2), overweight (25·0–29·9 kg/m2), obese (30·0–34·9 kg/m2) and morbidly obese (≥35·0 kg/m2). Of 5642 patients, 1362 (24·1 %) patients had a normal BMI, 2146 (38·0 %) were overweight, 1342 (23·8 %) were obese and 792 (14·0 %) were morbidly obese.

Results

Adjusted LOS was similar among normal (4·99 d), overweight (5·00 d), obese (5·02 d) and morbidly obese (5·17 d) patients (P= 0·20). Adjusted overall episode costs were no different (P= 0·23) between the groups of normal ($17 211), overweight ($17 462), obese ($17 195) and morbidly obese ($17 655) patients. Overall operative and anaesthesia costs were higher in the morbidly obese group ($5688) than in normal ($5553), overweight ($5549) and obese ($5593) patients (P= 0·03). Operating room costs were higher in morbidly obese patients ($3418) than in normal ($3276), overweight ($3291) and obese ($3340) patients (P< 0·001). Post-operative costs were no different (P= 0·30). Blood bank costs differed (P= 0·002) and were lower in the morbidly obese group ($180) compared with the other patient groups (P< 0·05). Other differences in costs were not significant. Morbidly obese patients were more likely to be transferred to a nursing home (24·1 %) than normal (18·4 %), overweight (17·9 %) or obese (16·0 %) patients (P= 0·001 each). There were no differences in the composite endpoint of 30 d mortality, re-admissions, re-operations or intensive care unit utilization.

Conclusions

BMI in patients undergoing primary elective THA did not impact LOS or overall institutional acute care costs, despite higher operative costs in morbidly obese patients. Obesity does not increase resource utilization for elective THA.

Obesity, diabetes, and smoking are important determinants of resource utilization in liver resection: a multicenter analysis of 1029 patients

OBJECTIVE

To investigate independent contributions of obesity, diabetes, and smoking to resource utilization in patients following liver resection.

SUMMARY BACKGROUND DATA

Despite being highly resource-intensive, liver resections are performed with increasing frequency. This study evaluates how potentially modifiable factors affect measures of resource utilization after hepatectomy.

METHODS

The American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) public-use database was queried for patients undergoing liver resection. Resource variables were operative time (OT), intraoperative transfusion, length of stay (LOS), ventilator support at 48 hours, and reoperation. Bivariable and multivariable linear and logistic regressions were performed.

RESULTS

There were 1029 patients identified. Most resections involved less than a hemiliver (599 patients, 58.2%). Mean BMI was 28.0 +/- 6.0. Mean OT was 253 +/- 122 minutes (range, 27 to 794) but varied by procedure (P < 0.001). Mean LOS was 8.7 +/- 10.7 days (range, 0 to 202). Morbid obesity added 48 minutes to OT (P = 0.018), 1.1 units to transfusions (P = 0.049), 2.2 days to LOS (P < 0.001), and accounted for delayed ventilator weaning (odds ratio, 4.5; P = 0.022). Underweight patients had shorter OT, but stayed 3.3 days longer than normal weight patients (P < 0.001). Insulin-treated patients with diabetes had longer OT (P < 0.001), increased transfusions (P < 0.001), and delayed ventilator weaning (odds ratio, 6.7; P < 0.001), while orally-treated patients with diabetes showed opposite trends. Smokers stayed 1.9 days longer (P < 0.001), with increased risk of prolonged ventilation (odds ratio, 3.3; P = 0.002) and reoperation (odds ratio, 2.3; P = 0.015).

CONCLUSION

Obesity, diabetes, and smoking are each associated with important components of healthcare expenditure. Education and prevention programs are needed to limit their impact on overall resource utilization.

Impact of obesity on hospitalized patients

Obesity is increasing at an alarming rate worldwide and is a risk factor for cardiac disease, diabetes, and stroke. This provides a challenge for the physicians caring for this patient population in the hospital. Skin integrity, medication dosing, testing, and nutrition are all altered by obesity. We summarize some of the current data on caring for the obese inpatient. Unfortunately, few data on this unique inpatient population exist.

Impact of overweight and obesity on hospitalization: race and gender differences

OBJECTIVE

To examine associations between weight status and number of all-cause and cause-specific hospitalizations overall, and by race and gender.

DESIGN

Longitudinal cohort study.

SUBJECTS

White and black adults (n=15 355) from the Atherosclerosis Risk in Communities Study who were normal weight (body mass index: >or=18.5 to <25.0 kg m(-2); n=4997), overweight (>or=25.0 to <30.0 kg m(-2); n=6100), or obese (>or=30.0 kg m(-2); n=4258) at baseline.

MEASUREMENTS

Information on hospitalizations was collected using community and cohort surveillance methods. Negative binomial models adjusted for race, gender, field center, age, physical activity, education level, smoking status, alcoholic beverage consumption and health insurance at baseline. Adjusted numbers of hospitalizations were calculated after setting covariates to the mean value (for continuous variables) or to the average distribution (for categorical variables) observed in the entire cohort and are expressed as the number of hospitalizations per 1000 adults followed over a period of 13 years.

RESULTS

The covariate-adjusted average number of all-cause hospitalizations was 1316 per 1000 normal weight, 1543 per 1000 overweight and 2025 per 1000 obese. Normal weight women had significantly fewer hospitalizations than normal weight men (1173 versus 1515 per 1000), but the increase associated with being obese on the number of all-cause hospitalizations was larger in women than men (791 versus 589 per 1000). There was no significant difference detected between the number of hospitalizations in normal weight whites and blacks, and the increase in hospitalizations with overweight or obesity was also not different. Effects of weight status on several primary causes of hospitalization differed by gender and race group.

CONCLUSION

Our work suggests that obesity prevention may reduce hospitalizations, a major component of rising healthcare costs. The impact of successful obesity prevention is likely to be larger in women than in men, and similar in blacks and whites.

Long-term obesity and avoidable hospitalization among younger, middle-aged, and older adults

BACKGROUND

Avoidable hospitalizations are considered to result from conditions that are preventable with timely and effective ambulatory care. We examined whether obesity, particularly long-term obesity, is associated with risk for and frequency of avoidable hospital stays.

METHODS

Data were drawn from the First National Health and Nutrition Examination Survey Epidemiological Follow-up Survey, a 20-year study of adults aged 25 to 74 years (N = 6833). Using measures of body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) at baseline and at 25 years of age, we estimated the effect of obesity (BMI > or =30.0) on avoidable hospitalization risk using Cox proportional hazards models, and we estimated its influence on the rate of avoidable stays per year using interval regression models. All multivariate analyses were adjusted for morbidity and other covariates.

RESULTS

One thousand twenty-three subjects experienced a hospitalization considered avoidable. Compared with normal-weight subjects, the adjusted hazard ratio of an avoidable stay among obese subjects was 1.82 (95% confidence interval [CI], 1.31-2.51) for those aged 25 to 44 years, 1.29 (95% CI, 1.05-1.59) for those aged 45 to 64 years, and 1.46 (95% CI, 1.23-1.74) for those 65 years and older. Among participants aged 45 to 64 years at baseline, obesity at 25 years of age was strongly associated with both the risk (hazard ratio, 1.91; 95% CI, 1.59-2.29) and frequency (beta coefficient, 0.057; SE, 0.018) of avoidable stays when accounting for baseline BMI category and additional covariates. For subjects 65 years and older, obesity at 25 years of age was associated with increased risk of avoidable hospitalization (hazard ratio, 1.87; 95% CI, 1.14-3.08) and with increased frequency of such admissions (beta coefficient, 0.138; SE, 0.038).

CONCLUSIONS

As indicated by its association with avoidable hospitalizations, long-term obesity is a substantial risk for complications in medical care. Interventions should target obesity early in the life course to help improve lifelong delivery of ambulatory care and to reduce strains on health care resources.

Obesity and hospitalization over the adult life course: does duration of exposure increase use?

Consistent with a new genre of research on life-course analyses of health-service use, this study explores the consequences of long-term exposure to a risk factor. Drawing from cumulative-disadvantage theory, the study examines whether obesity, especially chronic obesity, increases hospitalization admission and length of stay. Analyses make use of hospital records abstracted over 20 years from a national survey of adults 41 to 77 years of age at baseline (n = 4,574). Multiple measures of body weight are used to calculate adult obesity duration. Results reveal that obesity increased hospital admissions and length of stay over the 20 years studied. Among persons obese at any time during the study, years of obesity also led to longer stays. The findings highlight the utility of measures of the duration of risk exposure for both life-course studies of health and tests of cumulative-disadvantage theory.

Overweight and obesity in Italian adults 2004, and an overview of trends since 1983

OBJECTIVE

Overweight has been increasing in several developed countries over the last few decades. No update information on the issue is available for Italy.

DESIGN AND SETTING

We conducted a computer assisted personal in-house interview survey in March-April 2004, on a sample of 2932 Italian individuals (1407 men and 1525 women) aged 18 years or over, representative of the general adult Italian population. Information on weight and height was self-reported.

RESULTS

Overall, 3.4% of the Italian adult population were underweight (< 18.5 kg/m2, 0.9% of men and 5.8% of women), 31.3% were overweight (25.0-29.9 kg/m2, 38.4% of men, 24.7% of women), and 8.2% were obese (> or = 30.0 kg/m2, 7.4% of men and 8.9% of women). Overweight or obesity was reported by 14.2% of subjects aged 18-24 years (20.6% of men and 7.6% of women). The highest proportions of overweight and obese subjects were in the 45-64 year age group for men (51.4% overweight, 10.0% obese) and in the > or = 65 year age group for women (38.8% overweight, 13.8% obese). Age- and sex-standardised prevalence of overweight or obesity was 36.0% for more educated subjects, and 54.0% for less educated ones. It was 32.3% in northern, 44.3% in central and 47.0% in southern Italy. Overweight increased from 1983 to the early 1990s, and levelled off thereafter. Prevalence of obesity remained around 8-9% across the last 20 years.

CONCLUSIONS

Trends of overweight and obesity in Italy are more favourable than in several developed countries. Still, approximately 15 million of Italian adults are overweight and 4 million obese.

Obesity and risk for death due to motor vehicle crashes

OBJECTIVES

We examined the role of body mass index (BMI) and other factors in driver deaths within 30 days after motor vehicle crashes.

METHODS

We collected data for 22 107 drivers aged 16 years and older who were involved in motor vehicle crashes from the Crashworthiness Data System of the National Automotive Sampling System (1997-2001). We used logistic regression and adjusted for confounding factors to analyze associations between BMI and driver fatality and the associations between BMI and gender, age, seatbelt use, type of collision, airbag deployment, and change in velocity during a crash.

RESULTS

The fatality rate was 0.87% (95% confidence interval [CI]=0.50, 1.24) among men and 0.43% (95% CI=0.31, 0.56) among women involved as drivers in motor vehicle crashes. Risk for death increased significantly at both ends of the BMI continuum among men but not among women (P<.05). The association between BMI and male fatality increased significantly with a change in velocity and was modified by the type of collision, but it did not differ by age, seatbelt use, or airbag deployment.

CONCLUSIONS

The increased risk for death due to motor vehicle crashes among obese men may have important implications for traffic safety and motor vehicle design.

Bariatric Programs in Nursing Homes

The increase in prevalence of obesity in older individuals and the association of obesity with increased morbidity, functional decline, hospitalization, and complications is expected to increase the number of individuals who have obesity requiring nursing home care, particularly subacute and short-term rehabilitation. Providing appropriate nursing home care to residents who have obesity requires environmental modifications, specialized equipment, and staff training. Effective nursing home care of residents who have obesity is interdisciplinary and requires special nursing, medical, nutritional, psychosocial, and rehabilitation considerations.

Impact of obesity on resource utilization for general surgical procedures

OBJECTIVE

To determine the impact of the obesity epidemic on workload for general surgeons.

SUMMARY BACKGROUND DATA

In 2001, the prevalence of obesity in the United States reached 26%, more than double the rate in 1990. This study focuses on the impact of obesity on surgical practice and resource utilization.

METHODS

A retrospective analysis was done on patients undergoing cholecystectomy, unilateral mastectomy, and colectomy from January 2000 to December 2003 at a tertiary care center. The main outcome variables were operative time (OT), length of stay (LOS), and complications. The key independent variable was body mass index. We analyzed the association of obesity status with OT, LOS, and complications for each surgery, using multivariate regression models controlling for surgeon time-invariant characteristics.

RESULTS

There were 623 cholecystectomies, 322 unilateral mastectomies, and 430 colectomies suitable for analysis from 2000 to 2003. Multivariable regression analyses indicated that obese patients had statistically significantly longer OT (P < 0.01) but not longer LOS (P > 0.05) or more complications (P > 0.05). Compared with a normal-weight patient, an obese patient had an additional 5.19 (95% confidence interval [CI], 0.15-10.24), 23.67 (95% CI, 14.38-32.96), and 21.42 (95% CI, 9.54-33.30) minutes of OT with respect to cholecystectomy, unilateral mastectomy, and colectomy. These estimates were robust in sensitivity analyses.

CONCLUSIONS

Obesity significantly increased OT for each procedure studied. These data have implications for health policy and surgical resource utilization. We suggest that a CPT modifier to appropriately reimburse surgeons caring for obese patients be considered.