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Obesity may increase costs, hospital stay in patients with chest pain, dyspnea
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Patients who present to the ED with chest pain and dyspnea who have a higher BMI may also have increased health care costs and a longer length of hospital stay, according to new study findings.
“No study has examined the economic and operational impact of BMI in patients with chest complaints presenting to the ED. The objective was to measure the association of BMI with the main outcomes of cost of care, length of stay (including time in the ED and time in the wards if admitted) and radiation exposure in patients presenting to the ED with chest pain and dyspnea,” the researchers wrote.
The four-center, prospective outcomes study included 829 patients aged at least 17 years who were recruited through electronic tracking systems at EDs. Patients presented with both chest pain and dyspnea, but they had no known diagnosis at the time of enrollment.
The researchers evaluated outcomes at 90 days via telephone follow-up using validated questionnaires accompanied by review of each hospital’s electronic health record database. Outcomes that were stratified by BMI (underweight, normal weight, overweight, obese, morbidly obese) were compared using the Kruskal-Wallis rank test, and the researchers tested the independent predictive value of BMI.
Compared with normal-weight patients, costs of care were 22% higher for patients who were overweight (P=.077), 28% higher for patients who were obese (P=.02) and 41% higher for patients who were morbidly obese (P=.015). The researchers queried patient billing databases to obtain cumulative in-hospital medical costs for 30 days after study enrollment. Medical costs for all materials and services, including imaging, pharmacy and laboratory, were assessed.
The length of hospital stay for morbidly obese patients who did not undergo CT scanning was 34% longer compared with normal-weight patients (P=.073). The length of stay was 44% longer for morbidly obese patients who did undergo CT scanning compared with their normal-weight counterparts (P=.083).
At 90 days after CT pulmonary angiography, morbidly obese patients had the highest percentage (87%) of no significant cardiopulmonary diagnosis. Significant cardiopulmonary diagnosis was defined as death from any cause, diagnosis of ACS, pulmonary embolism, major adverse cardiac events, aortic aneurysm or dissection, other pulmonary diagnoses, dangerous mediastinal processes or treatment-related hemorrhage.
BMI was not identified as a significant predictor of radiation exposure in this study.
“These results emphasize a need for specific protocols to manage morbidly obese patients presenting to the ED with chest pain and dyspnea,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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