A. M. Hudnall1, C. Mullens3, D. Jackson1, M. Moore2, A. Wilson1, J. Bardes1 1West Virginia University, Department Of Surgery, Morgantown, WV, USA 2West Virginia University School of Medicine, Morgantown, WEST VIRGINIA, USA 3University Of Michigan, Department Of Surgery, Ann Arbor, MI, USA
Introduction:
Over the last 30 years, the United States has seen a continuous rise in obesity. Stratified by body mass index (BMI), we have seen negative effects of obesity throughout medicine. One segment of the population, the super morbidly obese (BMI > 60), has contributed to this rise yet has been understudied. In 2020 we presented data from a 5-year period at a single trauma center which showed an increase in mean hospital length of stay, percent of patients requiring ICU admission, percent of patients requiring mechanical ventilation, mean ICU length of stay, any complication and mortality rate. We postulated that super morbidly obese patients would require additional resources as an inpatient and would require more intensive discharge disposition (e.g. SNF vs. rehab vs. home health). This study aimed to quantify the impact a BMI > 50 had on these resources in trauma patients.
Methods:
This retrospective database study gathered data from all trauma activations at a single institution over a 5-year period to analyze the differences in outcomes for 6 specific healthcare outcomes compared between super morbidly obese and propensity score matched non-obese patients. Subjects were matched on age, sex, mechanism of injury, ISS, AIS, and then stratified by BMI.
Results:
This study evaluated 57 supermorbid obese subjects and 95 non obese. The average number of physical therapy (PT) visits (3.1 vs. 1.6, p = 0.0039), average number of occupational therapy (OT) visits (2.5 vs. 1.2, p = 0.005), total PT minutes (189 vs. 44.8, p = 0.0018), and total OT minutes (88.2 vs. 33.2, p = 0.0029) were all found to be statistically significant. Meanwhile, there was no statistical significance in full weight bearing status at discharge (16/55 for BMI > 60 vs. 30/93 for BMI < 60, p = 0.1623), discharge without assist devices (26/55 for BMI > 60 vs. 55/95 for BMI < 60, p = 0.1753), and discharge destination (home vs. rehabilitation vs. nursing facility).
Conclusion:
With increasing rates of obesity in the United States there will be an increasing emphasis on treatment of patients with obesity and obesity related complications. This becomes more important in the era of managed care and bundled billing for healthcare systems. Our study shows that patients with super morbid obesity require more frequent and prolonged therapy services during their admission as well as specific therapy equipment on discharge from the hospital, leading to increased healthcare spending and overall cost of admission.