By COLLEEN CREAMER
for VerusMed
A new study reported that body mass index has an impact only on patients who undergo open partial nephrectomy, not other nephrectomy procedures, and that length of stay is the main determinant of cost in renal surgeries.
In a cost impact study of obesity on partial and radical nephrectomy, researchers studied 237 patients who underwent open radical nephrectomy (ORN; n=48), laparoscopic radical nephrectomy (LRN; n=67), open partial nephrectomy (OPN; n=61) or laparoscopic partial nephrectomy (LPN; n=61) for a suspicious mass from October 2003 to January 2007.
For each surgical procedure, patients were divided into two groups: obese (BMI 30 kg/m2 or greater) or nonobese (BMI less than 30 kg/m2) based on the World Health Organization’s classification. Obese and nonobese patients were compared based on demographic, surgical and cost data. Mean BMI was similar for patients undergoing any procedure, but the OPN and LPN arms had higher proportions of obese individuals.
Cost data comprised total direct costs and subcosts, including anesthesia, laboratory, operating room service, radiology, room and board, pharmacy and surgical supplies.
The study revealed that direct costs were nearly $4,000 higher in the OPN group if patients were obese rather than nonobese ($10,187 vs. $6,538, respectively). Researchers found that there were no other differences in cost between obese and nonobese patients in the three other surgical groups.
Further, length of stay was significantly longer for obese patients in the OPN group than for the nonobese patients (5.4 days vs. 3.6 days). The study authors also found a higher incidence of complications in the OPN group that was obese rather than nonobese (36% vs. 16%), indicating that LOS and a higher incidence of complications were the main determinants for the disparity in the costs between the two OPN groups.
Regardless of BMI, the researchers noted, LOS was the main determinant of cost in renal surgery overall. Obesity was nearly a significant predictor of direct cost only in those who underwent OPN.
A possible explanation for the increased morbidity and cost parameters in the OPN cohort relative to the LPN group, the authors said, was that three surgeons with varying levels of expertise performed the OPN procedures, whereas the LPN procedures were performed by a single experienced surgeon.
Results of the study were reported in the May edition of The Journal of Urology.
