title: The economic impact of surgical care for morbidly obese endometrial cancer patients: a nationwide study.
abstract: BACKGROUND
  Obesity significantly impacts the cost of cancer treatment, yet the impact of morbid obesity on inpatient hospital charges related to endometrial cancer treatment is not well-defined.
  
  
  OBJECTIVE
  The purpose of this study was to determine the charges that are associated with inpatient surgery, hospitalization, and postoperative care of morbidly obese patients with endometrial cancer.
  
  
  METHODS
  Data were obtained from the National Inpatient Sample from 2010. Chi-square test, t-test, and linear regression were used for statistical analyses.
  
  
  RESULTS
  Six thousand five hundred sixty patients who underwent hysterectomy for endometrial cancer were identified. Mean age was 62 years (range, 22-99 years). The majority were white (78%), and the remainder were black (10%), Hispanic, (8%), Asian (3%), and Native American (1%). Insurance types were private (45%), Medicare (45%), Medicaid (5%), and uninsured (7%). One thousand eighty-eight of these patients (17%) were coded as morbidly obese. The mean postoperative stay for the morbidly obese was 4.0 days (range, 0-46 days) compared with 3.5 days (range, 0-81 days) for the non-morbidly obese patients (P < .01). Morbidly obese patients required more intensive care with mechanical ventilation (5.5% vs 1.6%; P < .01). The median hospital charges were higher for morbidly obese patients compared with their counterparts ($46,654 vs $41,164; P < .01). After adjustment for charges that were associated with insurance type, hospital type, and the surgery that was performed, the incremental increase in hospital charges that were associated with treating the morbidly obese patient was $5096 per patient (95% confidence interval, $2593-$7598; P < .01).
  
  
  CONCLUSIONS
  In this economic analysis, the health care charges that were associated with inpatient endometrial cancer treatment in the morbidly obese patient was significantly higher compared the non-morbidly obese patient. Resources are needed to support the needs of this population, and programs to encourage weight loss and optimize general health should be encouraged.
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University Of California San Francisco, San Francisco, CA. Electronic address: brooksra@obgyn.ucsf.edu.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Brooks
authors.affiliation: University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Blansit
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University Of California San Francisco, San Francisco, CA.
authors.forename: Nichole
authors.initials: N
authors.lastname: Young-Lin
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University Of California San Francisco, San Francisco, CA.
authors.forename: Irina
authors.initials: I
authors.lastname: Usach
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University Of California San Francisco, San Francisco, CA.
authors.forename: Lee May
authors.initials: LM
authors.lastname: Chen
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, TN.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Radiation Oncology, Stanford Cancer Center, Stanford University, Stanford, CA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Kapp
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University Of California San Francisco, San Francisco, CA; California Pacific/Palo Alto Medical Foundation, Sutter Research Institute, Palo Alto, CA.
authors.forename: John K
authors.initials: JK
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D016889:Endometrial Neoplasms / Q000191:economics* / Q000601:surgery*; D005260:Female; D006306:Health Surveys; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000191:economics*; D010535:Laparoscopy / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D009767:Obesity, Morbid / Q000191:economics*; D012121:Respiration, Artificial / Q000191:economics / Q000706:statistics & numerical data; D065287:Robotic Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
keywords: endometrial cancer; health care expenditure; hospitalization; obesity