Pay for Obesity? Pay-for-Performance Metrics Neglect Increased Complication Rates and Cost for Obese Patients

Kenzo Hirose, Andrew Daniel Shore, Elizabeth C. Wick, Jonathan P. Weiner, Martin A. Makary

Research output: Contribution to journalArticlepeer-review


Background: Rates of surgical complications are increasingly being used for pay-for-performance reimbursement structures. We hypothesize that morbid obesity has a significant effect on complication rates and costs following commonly performed general surgical procedures. Methods: We studied 30,502 patients who underwent cholecystectomy for cholecystitis and 6,390 patients who underwent appendectomy for acute appendicitis using administrative claims data from seven Blue Cross and Blue Shield Plans over a 7-year period (2002-2008). We compared 30-day complications as well as total 30-day direct medical costs for obese and non-obese patients. Multivariate regressions were performed to determine the relationship of morbid obesity to complications and cost. Results: Obese patients were more likely to have a complication within 30 days after surgery than non-obese patients (19.2% vs. 15.7% for cholecystectomy, p < 0.0001; 20.2% vs. 15.2%, p < 0.0001, for appendectomy). The mean total 30-day postoperative cost for obese patients were $1,109 higher following a cholecystectomy (p < 0. 0001) and $666 higher following an appendectomy (p = 0.09). Conclusion: Morbid obesity is associated with a higher rate of complications for two commonly performed general surgical procedures and is associated with higher costs for cholecystectomy. Pay-for-performance metrics should account for the increased risk of complications and higher cost in this population.

Original languageEnglish (US)
Pages (from-to)1128-1135
Number of pages8
JournalJournal of Gastrointestinal Surgery
Issue number7
StatePublished - Jul 2011


  • Appendectomy
  • Cholecystectomy
  • Cost
  • Obesity
  • Pay for performance

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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