Obese patients undergoing elective plastic surgery are 12 times more likely to suffer complications than those of normal weight.
"Our data demonstrate that obesity is a major risk factor for complications following certain kinds of elective surgery," said lead author Marty Makary, M.D., M.P.H, an associate professor of surgery at the Johns Hopkins University School of Medicine.
"Operations on obese patients are more taxing. These surgeries take usually take longer, the operating fields are deeper, the spaces in which an infection can set in are often greater and blood flow in fat tissue is less than in other types of tissue, which results in slower healing," he said.
And yet, "payments are based on the complexity of the procedure and are not adjusted for the complexity of the patient," he added.
In the study, Makary and his colleagues examined insurance claims data from seven Blue Cross and Blue Shield plans and identified patients who underwent elective breast procedures covered by insurance between 2002 and 2006.
There were 2,403 patients in the obese group and 5,597 patients in the normal weight control group. The most common procedure, by far, was breast reduction, followed by breast reconstruction, augmentation and mastopexy (breast lift).
Within 30 days of surgery, 18.3 percent of the obese group experienced at least once complication, compared to 2.2 percent of patients in the control group.
The differences between the two groups were most pronounced in complications, such as inflammation (with obese patients 22 times more likely to suffer a complication), infection (13 times) and pain (11 times).
The study is published online in the journal Plastic and Reconstructive Surgery.