title: Attributable cost of obesity in breast surgery: a matched cohort analysis.
abstract: BACKGROUND
  The purpose of this study was to determine the economic impact of obesity on patients undergoing mastectomy and breast conservation (BC) for breast cancer.
  
  
  METHODS
  An analysis of female patients greater than or equal to 18 years undergoing mastectomy and BC for breast cancer between 2004 and 2010 using the Nationwide Inpatient Sample was conducted.
  
  
  RESULTS
  Of 55,903 patients in our study (49,985 mastectomy, 5,918 BC), 3,308 patients (5.92%) were obese. After propensity score matching, the cost for obese patients was higher at $1,826 (P < .0001) for mastectomy and $1,702 for BC (P < .0001). These costs were not significantly associated with overall complications and length of stay for mastectomy in the matched comparison group and not associated with overall complications and minimally associated with longer length of stay in the BC group.
  
  
  CONCLUSIONS
  By controlling for other patient factors, this study shows that obesity is attributable to a significantly higher cost for both BC (29%) and mastectomy (23%).
authors.affiliation: Department of Surgery, The Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: ssun1@hmc.psu.edu.
authors.forename: Susie X
authors.initials: SX
authors.lastname: Sun
authors.affiliation: Department of Surgery, The Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA.
authors.forename: Erin K
authors.initials: EK
authors.lastname: Greenleaf
authors.affiliation: Department of Surgery, The Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA; Department of Public Health Sciences, The Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.affiliation: Department of Surgery, The Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Leung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications* / Q000191:economics / Q000601:surgery*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008408:Mastectomy / Q000009:adverse effects / Q000191:economics*; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000191:economics*; D057216:Propensity Score; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Breast conservation; Cost; Mastectomy; Obesity; Partial mastectomy; Resource utilization