PURPOSE:The purpose of this study is to evaluate the outcomes of morbidly obese inpatients.
METHODS:This is a retrospective cohort study.We included all adult morbidly obese patients (defined as body mass index BMI above 40) admitted to tertiary university hospital in 2000–2008.Primary outcome was hospital mortality.Secondary outcomes were incidence of venous thromboembolism VTE, hospital and intensive care ICU unit length of stay LOS, need and duration of mechanical ventilation and tracheostomy rates. We divided patients into quartiles based on their admission BMI. Baseline characteristics and outcomes were evaluated among quartiles.
RESULTS:Over 8-year period, we reviewed 897 admissions for 367 patients. Median Number of admissions was 10 per patient with a range of 1–20. 40.9% had more than one admission (figure 1).Compared to the lowest, higher BMI Quartiles were older, had more medical and female patients, had higher rates of diabetes, congestive heart failure and coronary artery disease, and had higher rates of ICU admissions, mechanical ventilations and tracheostomy (table 1). Although the higher BMI quartiles had longer hospital LOS, hospital mortality and VTE rates did not significantly differ (range between 4.1%–7.6%; p=0.409).150 (40.87 %) patients had a total of 224 ICU admissions. Majority of those had one ICU admission (114, 76%).Median number of ICU admission was 4(range 1–11) . There were no differences in primary and secondary end points among the four ICU BMI-quartiles.
CONCLUSION:Morbidly obese patients required high number of hospital admissions.Higher BMI quartiles were older and had higher female percentage, more co-morbid conditions and higher rates of ICU admissions, mechanical ventilation and tracheostomy;however hospital mortality rates were not high and did not increase with higher BMI.
CLINICAL IMPLICATIONS:As morbid obesity rates increase,healthcare workers wil face a major challenge. Although morbidly obese patients utilize hospital resources more likely than any other, hospital mortality rates are not different . This will be and probably is a major challenge facing healthcare expenditure in USA. Our findings call for national efforts to explore options to deal with this emerging challenge.
DISCLOSURE:Blair Westerly, No Financial Disclosure Information; No Product/Research Disclosure Information