title: Association of body mass index with increased cost of care and length of stay for emergency department patients with chest pain and dyspnea.
abstract: BACKGROUND
  High body mass index (BMI) increases the probability of indeterminate findings on diagnostic studies, length of stay, and cost of care for hospitalized patients. No study has examined the economic and operational impact of BMI in patients with chest complaints presenting to the emergency department (ED). The objective was to measure the association of BMI with the main outcomes of cost of care, length of stay (including time in the ED and time in the wards if admitted), and radiation exposure in patients presenting to the ED with chest pain and dyspnea.
  
  
  RESULTS
  This was a prospective, 4-center, outcomes study. Patients were adults with dyspnea and chest pain, nondiagnostic electrocardiograms, and no obvious diagnosis. Patients were followed for the main outcomes for 90 days. Outcomes that were stratified by BMI in 5 categories, underweight, normal weight, overweight, obese, and morbidly obese, were compared using the Kruskall-Wallis rank test, and the independent predictive value of BMI was tested with multivariate regressions. Compared with medical costs for normal weight patients, costs were 22% higher for overweight patients (P=0.077), 28% higher for obese patients (P=0.020), and 41% higher for morbidly obese patients (P=0.015). Morbidly obese patients without computerized tomographic scanning stayed in the hospital 34% longer than normal weight patients (P=0.073), and morbidly obese patients with computerized tomographic scanning stayed in the hospital 44% longer than normal weight patients (P=0.083). BMI was not a significant predictor of radiation exposure. Morbidly obese patients had the highest proportion (87%) of no significant cardiopulmonary diagnosis for 90 days after computerized tomographic pulmonary angiography.
  
  
  CONCLUSIONS
  BMI was associated with increases in cost of care and length of hospital stay for patients with chest pain and dyspnea. These results emphasize a need for specific protocols to manage morbidly obese patients presenting to the ED with chest pain and dyspnea. Clinical Trial Registration- http://www.clinicaltrials.gov. Unique identifier: NCT01059500.
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: Peitz
authors.forename: Jennifer
authors.initials: J
authors.lastname: Troyer
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
authors.forename: Nathan I
authors.initials: NI
authors.lastname: Shapiro
authors.forename: R Darrell
authors.initials: RD
authors.lastname: Nelson
authors.forename: Jackeline
authors.initials: J
authors.lastname: Hernandez
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kline
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D015992:Body Mass Index; D002637:Chest Pain / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004417:Dyspnea / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D004636:Emergency Service, Hospital; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011839:Radiation, Ionizing; D016896:Treatment Outcome; D055815:Young Adult
keywords: body mass index; economics; health care economics and organizations; obesity