Research Suggests Obesity Increases Risk of Negative Hospital Outcomes, Except Mortality

Hospitalized patients who are obese are more likely to be readmitted and have longer and costlier inpatient stays, but tend to have lower mortality rates, according to new research presented at Digestive Disease Week 2017, held May 6-9 in Chicago, Illinois.

Despite the rising rates of obesity, few studies have examined its impact on patients’ hospital outcomes, including readmissions, length of stay, costs, and mortality. Lead author Allison Schulman, MD, of Brigham & Women’s Hospital in Boston, told The American Journal of Managed Care^® that the current study had 3 main objectives: figuring out how obese patients fared in the hospital, their likelihood of readmission, and their outcomes during the second hospitalization.

To assess these outcomes, Schulman and her team used the 2013 National Readmission Database to compare readmissions for patients with obesity and those without, after adjusting for patient characteristics like age, sex, and comorbidities, as well as hospital information like rural location and size.

“Interestingly, obese patients were more likely to be admitted to the hospital initially and to be readmitted, but their inpatient mortality was actually improved,” Schulman explained. “We also looked at other secondary outcomes such as length of stay and total hospital charges, and those were both increased despite the fact that mortality was improved.”

Specifically, the obese patients were readmitted 32% of the time, while just 20% of the non-obese patients were readmitted. The obese patients also had a significantly increased length of stay and total charges than those who were not obese. However, the most surprising finding was that obese patients had a 0.70 odds ratio for mortality compared to non-obese patients, indicating that obesity was a protective factor.

Asked about potential explanations for this finding, Schulman explained that “one of the major indications for admission is cancer diagnoses and morbid, very aggressive illness,” so it is possible that obesity was an indicator for “patients who are still robust.” In other words, obesity “could be almost the opposite marker of cachexia.”

There were also some diagnosis-specific findings; for instance, obese patients with cancer who were readmitted were more likely to stay longer and incur higher costs than during the first admission. In future research, Schulman plans to delve further into “what specific diagnoses may be linked to improved mortality” and “which ones are the most predictive of outcome.”

As far as the larger impact of the findings, Schulman said that “the fact that patients who are obese are in the hospital an increasing amount of time, costing the healthcare system even more money, speaks to the fact that we need to be on the prevention side of obesity as opposed to the treatment side.” She explained that some of her other research focuses on obesity prevention and management, in the hopes that a multidisciplinary team can help patients lose weight before they are hospitalized.

“There’s a lot of research going on right now nationwide as to how can we predict who will respond to these therapies and who will do well without having long lengths of stay and increasing hospital charges,” she said, adding that we are in “a really exciting time” for advances in weight loss therapies.

“I think we’ve seen as surgeons over the past couple years more and more bariatric centers of excellence, which I think is what’s really required to manage this to its fullest,” Schulman said.