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Obesity increases surgery time, cost in patients with lung cancer
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In a recent study published in The Annals of Thoracic Surgery, researchers determined that for every 10-unit increase in BMI, operating room time increased by 7.2 minutes for lung cancer patients undergoing lobectomy. While this increase may not seem substantial, researchers suggest the cost burden is more worrisome.
“The fact that we are putting more and more costly resources into caring for obese patients needs to be considered as hospitals and policy makers think of ways to control future health care costs. More public health emphasis on healthy lifestyle choices and weight loss is needed,” researcher Jamii B. St. Julien, MD, MPH, from Vanderbilt University Medical Center in Nashville, said in a press release.
St. Julien and colleagues included lung cancer patients in The Society of Thoracic Surgeons General Thoracic Surgery database (STS GTSD) who also underwent lobectomy as a primary procedure between 2006-2010 (n=19,337) for the multi-institutional, retrospective study.
Mean BMI measurements were 27.3 kg/m2 for 13,222 patients (68.4%) with a BMI <30 kg/m2; 4,898 patients (25.3%) had a BMI of 30 kg/m2 or more; and 625 patients were morbidly obese. There was no BMI data for 1,217 patients (6.3%), researchers wrote.
Prior to multivariate regression analysis, the average total operating room time was 240.1 minutes; preprocedure time was 48.4 minutes, procedure time was 174.1 minutes and postprocedure time was 17.4 minutes. The researchers said that length of stay tended to be 6.9 days, with an average 1.8% overall 30-day mortality rate.
Upon further analysis, the researchers wrote that for every 10-unit increase in BMI, there was a 7.2-minute increase in operating room time (P<.0001).
“For example, a lobectomy in a patient with a BMI of 45 kg/m2 takes approximately 15 minutes longer than for a patient with a BMI of 25 kg/m2,” researchers wrote.
This increase in operating room time led to cost estimates within the study. Every 10-unit increase in BMI has the potential to cost an additional $446, the researchers wrote. However, it remains difficult to estimate the true cost, they added.
“As any clinician will attest, an additional 7 minutes of total operating room time for an obese patient hardly seems clinically significant. However, I do not believe the authors consider this clinically relevant either,” David R. Jones, MD, from the department of surgery in the division of thoracic and cardiovascular surgery at the University of Virginia, wrote in an invited commentary accompanying the study. “Instead, I think the intent of this publication is to begin the process of deducing the true cost of performing thoracic procedures in the ever-increasing obese population.”
Jones wrote that he agrees more obese patients will require thoracic surgical procedures, and that a better understanding of both the obesity and lung cancer epidemic is valuable.
Disclosure: Grogan is a recipient of the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service career Development Award. St. Julien is a recipient of the Vanderbilt University Surgical Oncology T32 Training Grant. All other researchers report no relevant financial disclosures.
Perspective
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George A. Bray, MD
Obesity is a common problem and carries with it the risk for many kinds of other ailments. It can also be a handicap when it comes to surgical and other medical proceures. This is clearly illustrated in this paper on surgical treatment. Obesity can also pose challenges for anesthesia during surgery, for post-operative recovery and for wound healing in the post-operative state.
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