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Original Article

Association of Body Mass Index With Increased Cost of Care and Length of Stay for Emergency Department Patients With Chest Pain and Dyspnea

Geoffrey W. Peitz, Jennifer Troyer, Alan E. Jones, Nathan I. Shapiro, R. Darrell Nelson, Jackeline Hernandez, Jeffrey A. Kline
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https://doi.org/10.1161/CIRCOUTCOMES.113.000702
Circulation: Cardiovascular Quality and Outcomes. 2014;CIRCOUTCOMES.113.000702
Originally published March 4, 2014
Geoffrey W. Peitz
From the Indiana University School of Medicine, Indianapolis, IN (G.W.P.); UNC Charlotte, Belk College of Business, Charlotte, NC (J.T.); Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS (A.E.J.); Department of Emergency Medicine and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (N.I.S.); Department of Emergency Medicine, Wake Hospital and University of North Carolina School of Medicine, Raleigh, NC (R.D.N.); Department of Emergency Medicine, Charlotte, NC (J.H.); and Departments of Emergency Medicine and Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN (J.A.K.).
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Jennifer Troyer
From the Indiana University School of Medicine, Indianapolis, IN (G.W.P.); UNC Charlotte, Belk College of Business, Charlotte, NC (J.T.); Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS (A.E.J.); Department of Emergency Medicine and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (N.I.S.); Department of Emergency Medicine, Wake Hospital and University of North Carolina School of Medicine, Raleigh, NC (R.D.N.); Department of Emergency Medicine, Charlotte, NC (J.H.); and Departments of Emergency Medicine and Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN (J.A.K.).
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Alan E. Jones
From the Indiana University School of Medicine, Indianapolis, IN (G.W.P.); UNC Charlotte, Belk College of Business, Charlotte, NC (J.T.); Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS (A.E.J.); Department of Emergency Medicine and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (N.I.S.); Department of Emergency Medicine, Wake Hospital and University of North Carolina School of Medicine, Raleigh, NC (R.D.N.); Department of Emergency Medicine, Charlotte, NC (J.H.); and Departments of Emergency Medicine and Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN (J.A.K.).
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Nathan I. Shapiro
From the Indiana University School of Medicine, Indianapolis, IN (G.W.P.); UNC Charlotte, Belk College of Business, Charlotte, NC (J.T.); Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS (A.E.J.); Department of Emergency Medicine and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (N.I.S.); Department of Emergency Medicine, Wake Hospital and University of North Carolina School of Medicine, Raleigh, NC (R.D.N.); Department of Emergency Medicine, Charlotte, NC (J.H.); and Departments of Emergency Medicine and Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN (J.A.K.).
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R. Darrell Nelson
From the Indiana University School of Medicine, Indianapolis, IN (G.W.P.); UNC Charlotte, Belk College of Business, Charlotte, NC (J.T.); Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS (A.E.J.); Department of Emergency Medicine and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (N.I.S.); Department of Emergency Medicine, Wake Hospital and University of North Carolina School of Medicine, Raleigh, NC (R.D.N.); Department of Emergency Medicine, Charlotte, NC (J.H.); and Departments of Emergency Medicine and Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN (J.A.K.).
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Jackeline Hernandez
From the Indiana University School of Medicine, Indianapolis, IN (G.W.P.); UNC Charlotte, Belk College of Business, Charlotte, NC (J.T.); Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS (A.E.J.); Department of Emergency Medicine and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (N.I.S.); Department of Emergency Medicine, Wake Hospital and University of North Carolina School of Medicine, Raleigh, NC (R.D.N.); Department of Emergency Medicine, Charlotte, NC (J.H.); and Departments of Emergency Medicine and Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN (J.A.K.).
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Jeffrey A. Kline
From the Indiana University School of Medicine, Indianapolis, IN (G.W.P.); UNC Charlotte, Belk College of Business, Charlotte, NC (J.T.); Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS (A.E.J.); Department of Emergency Medicine and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (N.I.S.); Department of Emergency Medicine, Wake Hospital and University of North Carolina School of Medicine, Raleigh, NC (R.D.N.); Department of Emergency Medicine, Charlotte, NC (J.H.); and Departments of Emergency Medicine and Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN (J.A.K.).
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Abstract

Background—High body mass index (BMI) increases the probability of indeterminate findings on diagnostic studies, length of stay, and cost of care for hospitalized patients. No study has examined the economic and operational impact of BMI in patients with chest complaints presenting to the emergency department (ED). The objective was to measure the association of BMI with the main outcomes of cost of care, length of stay (including time in the ED and time in the wards if admitted), and radiation exposure in patients presenting to the ED with chest pain and dyspnea.

Methods and Results—This was a prospective, 4-center, outcomes study. Patients were adults with dyspnea and chest pain, nondiagnostic electrocardiograms, and no obvious diagnosis. Patients were followed for the main outcomes for 90 days. Outcomes that were stratified by BMI in 5 categories, underweight, normal weight, overweight, obese, and morbidly obese, were compared using the Kruskall–Wallis rank test, and the independent predictive value of BMI was tested with multivariate regressions. Compared with medical costs for normal weight patients, costs were 22% higher for overweight patients (P=0.077), 28% higher for obese patients (P=0.020), and 41% higher for morbidly obese patients (P=0.015). Morbidly obese patients without computerized tomographic scanning stayed in the hospital 34% longer than normal weight patients (P=0.073), and morbidly obese patients with computerized tomographic scanning stayed in the hospital 44% longer than normal weight patients (P=0.083). BMI was not a significant predictor of radiation exposure. Morbidly obese patients had the highest proportion (87%) of no significant cardiopulmonary diagnosis for 90 days after computerized tomographic pulmonary angiography.

Conclusions—BMI was associated with increases in cost of care and length of hospital stay for patients with chest pain and dyspnea. These results emphasize a need for specific protocols to manage morbidly obese patients presenting to the ED with chest pain and dyspnea.

Clinical Trial Registration Information URL—http://www.clinicaltrials.gov. Unique identifier: NCT01059500.

  • body mass index
  • economics
  • health care economics and organizations
  • obesity
  • Received October 28, 2013.
  • Accepted February 10, 2014.
  • © 2014 American Heart Association, Inc.
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    Association of Body Mass Index With Increased Cost of Care and Length of Stay for Emergency Department Patients With Chest Pain and Dyspnea
    Geoffrey W. Peitz, Jennifer Troyer, Alan E. Jones, Nathan I. Shapiro, R. Darrell Nelson, Jackeline Hernandez and Jeffrey A. Kline
    Circulation: Cardiovascular Quality and Outcomes. 2014;CIRCOUTCOMES.113.000702, originally published March 4, 2014
    https://doi.org/10.1161/CIRCOUTCOMES.113.000702

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    Association of Body Mass Index With Increased Cost of Care and Length of Stay for Emergency Department Patients With Chest Pain and Dyspnea
    Geoffrey W. Peitz, Jennifer Troyer, Alan E. Jones, Nathan I. Shapiro, R. Darrell Nelson, Jackeline Hernandez and Jeffrey A. Kline
    Circulation: Cardiovascular Quality and Outcomes. 2014;CIRCOUTCOMES.113.000702, originally published March 4, 2014
    https://doi.org/10.1161/CIRCOUTCOMES.113.000702
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