The impact of hyperglycemia and obesity on hospitalization costs and clinical outcome in general surgery patients

• Type of Material: Article
• Authors: Lauren Buehler, Emory University; Maya Fayfman, Emory University; Anastasia Alexopoulos, Emory University; Liping Zhao, Emory University; Farnoosh Farrokhi, Emory University; Jeff Weaver, Emory University; Dawn Smiley-Byrd, Emory University; Francisco Pasquel, Emory University; Priyathama Vellanki, Emory University; Guillermo Umpierrez, Emory University
• Language: English
• Date: 2015-11-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jdiacomp.2015.07.027
• Title of Journal or Parent Work: JOURNAL OF DIABETES AND ITS COMPLICATIONS
• Volume: 29
• Issue: 8
• Start Page: 1177
• End Page: 1182
• Keywords: ASSOCIATION; Obesity; Obesity paradox; Life Sciences & Biomedicine; MANAGEMENT; ALL-CAUSE MORTALITY; OVERWEIGHT; Hospitalization costs; MORBIDITY; DIABETIC-PATIENTS; PREVALENCE; Inpatient hyperglycemia; Science & Technology; BODY-MASS INDEX; ACUTE KIDNEY INJURY; Endocrinology & Metabolism; Type 2 diabetes; RISK

Abstract

Background The impact of obesity on clinical outcomes and hospitalization costs in general surgery patients with and without diabetes (DM) is unknown. Materials and 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/m2 and obesity as a BMI ≥ 30 kg/m2. 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. Conclusion 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.