Obesity Increases Work Required for Complex Abdominal Surgery without Commensurate Reimbursement

Childers CP, Petty AM, Selzer DJ, et al. Obesity and Work in Abdominal Surgery. J Am Coll Surg. 2025; in press.

Current medical payment systems do not provide adequate measures for documentation of the increased work required for surgical management of patients with complex diseases and multiple comorbidities.

This study used data from the ACS NSQIP database (n = 158,692) to determine the effect of patient obesity on indicators of surgeon “work” (operative time and rates of complications) for a group of abdominal operations including appendectomy, cholecystectomy, colorectal procedures, and hernia repair.

Obesity was graded according to BMI category (Class I–III). Obesity was diagnosed in 76.3% of the patient cohort. The data showed that operative time increased 5.6%–26.8% according to obesity category. Rates of complications (primarily wound, thromboembolic, and renal complications) were significantly increased in obese patients.

The authors noted that, given the continuing reductions in reimbursement for complex patient care, these findings could be used for realigning payment codes so that the additional work needed to provide high-quality care to complex patients is fairly compensated.