title: Obesity and readmission in elderly surgical patients.
abstract: BACKGROUND
  Reducing readmissions has become a focus in efforts by Medicare to improve health care quality and reduce costs. This study aimed to determine whether causes for readmission differed between obese and nonobese patients, possibly allowing for targeted interventions.
  
  
  METHODS
  A matched case control study of Medicare patients admitted between 2002 and 2006 who were readmitted after hip or knee surgery, colectomy, or thoracotomy was performed. Patients were matched exactly for procedure, while also balancing on hospital, age, and sex. Conditional logistic regression was used to study the odds of readmission for very obese cases (body mass index >35 kg/m2) versus normal weight patients (body mass index of 20-30 kg/m2) after also controlling for race, transfer-in and emergency status, and comorbidities.
  
  
  RESULTS
  Among 15,914 patient admissions, we identified 1,380 readmitted patients and 2,760 controls. The risk of readmission was increased for obese compared to nonobese patients both before and after controlling for comorbidities (before: odds ratio, 1.35; P = .003; after: odds ratio, 1.25; P = .04). Reasons for readmission varied by procedure but were not different by body mass index category.
  
  
  CONCLUSIONS
  Obese patients have an increased risk of readmission, yet the reasons for readmission in obese patients appear to be similar to those for nonobese patients, suggesting that improved postdischarge management for the obese cannot focus on a few specific causes of readmission but must instead provide a broad range of interventions.
authors.affiliation: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Reinke
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.forename: Jose R
authors.initials: JR
authors.lastname: Zubizarreta
authors.forename: Lanyu
authors.initials: L
authors.lastname: Mi
authors.forename: Philip
authors.initials: P
authors.lastname: Saynisch
authors.forename: Fabienne A
authors.initials: FA
authors.lastname: Kyle
authors.forename: Orit
authors.initials: O
authors.lastname: Even-Shoshan
authors.forename: Lee A
authors.initials: LA
authors.lastname: Fleisher
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Silber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009765:Obesity / Q000453:epidemiology*; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000145:classification / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology