The impact of hyperglycemia and obesity on hospitalization costs and clinical outcome in general surgery patients.
BACKGROUND
The impact of obesity on clinical outcomes and hospitalization costs in general surgery patients with and without diabetes (DM) is unknown.


METHODS
We reviewed medical records of 2451 patients who underwent gastrointestinal surgery at two university hospitals. Hyperglycemia was defined as BG ≥140 mg/dl. Overweight was defined by body mass index (BMI) between 25-29.9 kg/m(2) and obesity as a BMI ≥30 kg/m(2). Hospital cost was calculated using cost-charge ratios from Centers for Medicare and Medicaid Services. Hospital complications included a composite of major cardiovascular events, pneumonia, bacteremia, acute kidney injury (AKI), respiratory failure, and death.


RESULTS
Hyperglycemia was present in 1575 patients (74.8%). Compared to patients with normoglycemia, those with DM and non-DM with hyperglycemia had higher number of complications (8.9% vs. 35.8% vs. 30.0%, p<0.0001), longer hospital stay (5 days vs. 9 days vs. 9 days, p<0.0001), more readmissions within 30 days (9.3% vs. 18.8% vs. 17.2%, p<0.0001), and higher hospitalization costs ($20,273 vs. $79,545 vs. $72,675, p<0.0001). In contrast, compared to normal-weight subjects, overweight and obesity were not associated with increased hospitalization costs ($58,313 vs. $58,173 vs. $66,633, p=0.74) or risk of complications, except for AKI (11.9% vs. 14.8% vs. 20.5%, p<0.0001). Multivariate analysis revealed that DM (OR=4.4, 95% CI=2.8,7.0) or perioperative hyperglycemia (OR=4.1, 95% CI=2.7-6.2) were independently associated with increased risk of complications.


CONCLUSIONS
Hyperglycemia but not increasing BMI, in patients with and without diabetes undergoing gastrointestinal surgery was associated with a higher number of complications and hospitalization costs.
Emory University Department of Medicine, Atlanta, GA, USA.
Lauren
L
Buehler
Emory University Department of Medicine, Atlanta, GA, USA.
Maya
M
Fayfman
Emory University Department of Medicine, Atlanta, GA, USA.
Anastasia-Stefania
AS
Alexopoulos
Emory University Rollins School of Public Health, Atlanta, GA, USA.
Liping
L
Zhao
Emory University Department of Medicine, Atlanta, GA, USA.
Farnoosh
F
Farrokhi
Information Technology, Emory University, Atlanta, GA, USA.
Jeff
J
Weaver
Emory University Department of Medicine, Atlanta, GA, USA.
Dawn
D
Smiley-Byrd
Emory University Department of Medicine, Atlanta, GA, USA.
Francisco J
FJ
Pasquel
Emory University Department of Medicine, Atlanta, GA, USA.
Priyathama
P
Vellanki
Emory University Department of Medicine, Atlanta, GA, USA. Electronic address: geumpie@emory.edu.
Guillermo E
GE
Umpierrez
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000191:economics / Q000628:therapy*; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000191:economics / Q000601:surgery*; D005845:Georgia / Q000453:epidemiology; D017721:Hospital Costs; D006785:Hospitals, University; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D010359:Patient Readmission; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D012306:Risk; D016896:Treatment Outcome
Hospitalization costs; Inpatient hyperglycemia; Obesity; Obesity paradox; Type 2 diabetes