title: Economies of scale: body mass index and costs of cardiac surgery in Ontario, Canada.
abstract: An obesity paradox has been described, whereby obese patients have better health outcomes than normal weight patients in certain clinical situations, including cardiac surgery. However, the relationship between body mass index (BMI) and resource utilization and costs in patients undergoing coronary artery bypass graft (CABG) surgery is largely unknown. We examined resource utilization and cost data for 53,224 patients undergoing CABG in Ontario, Canada over a 10-year period between 2002 and 2011. Data for costs during hospital admission and for a 1-year follow-up period were derived from the Institute for Clinical Evaluative Sciences, and analyzed according to pre-defined BMI categories using analysis of variance and multivariate models. BMI independently influenced healthcare costs. Underweight patients had the highest per patient costs ($50,124 ± $36,495), with the next highest costs incurred by morbidly obese ($43,770 ± $31,747) and normal weight patients ($42,564 ± $30,630). Obese and overweight patients had the lowest per patient costs ($40,760 ± $30,664 and $39,960 ± $25,422, respectively). Conversely, at the population level, overweight and obese patients were responsible for the highest total yearly population costs to the healthcare system ($92 million and $50 million, respectively, compared to $4.2 million for underweight patients). This is most likely due to the high proportion of CABG patients falling into the overweight and obese BMI groups. In the future, preoperative risk stratification and preparation based on BMI may assist in reducing surgical costs, and may inform health policy measures aimed at the management of weight extremes in the population.
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada.|Institute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston, ON, K7L 3N6, Canada.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Johnson
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. parlowj@queensu.ca.
authors.forename: Joel L
authors.initials: JL
authors.lastname: Parlow
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Milne
authors.affiliation: Institute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston, ON, K7L 3N6, Canada.
authors.forename: Marlo
authors.initials: M
authors.lastname: Whitehead
authors.affiliation: Institute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston, ON, K7L 3N6, Canada.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Xu
authors.affiliation: Institute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston, ON, K7L 3N6, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Rohland
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
authors.forename: Joelle B
authors.initials: JB
authors.lastname: Thorpe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001026:Coronary Artery Bypass / Q000191:economics*; D017281:Cost of Illness; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000191:economics*; D009864:Ontario; D013851:Thinness / Q000191:economics*; D013903:Thoracic Surgery / Q000191:economics
keywords: Body mass index; Cardiac surgery outcomes; Healthcare costs; Obesity paradox; Public health