The impact of morbid obesity on resource utilization after renal transplantation

Abstract

Background A growing number of renal transplant recipients have a body mass index ≥40. While previous studies have shown that patient and graft survival are significantly decreased in renal transplant recipients with body mass indexes ≥40, less is known about perioperative outcomes and resource utilization in morbidly obese patients. We aimed to analyze the effects of morbid obesity on these parameters in renal transplant. Methods Using a linkage between the Scientific Registry of Transplant Recipients and the databases of the University HealthSystem Consortium, we identified 29,728 adult renal transplant recipients and divided them into 2 cohorts based on body mass index (<40 vs ≥40 kg/m2). The body mass index ≥40 group comprised 2.5% (n = 747) of renal transplant recipients studied. Results Body mass index ≥40 recipients incurred greater direct costs ($84,075 vs $79,580, P <.01), index admission costs ($91,169 vs $86,141, P <.01), readmission costs ($5,306 vs $4,596, P = .01), and combined costs ($99,590 vs $93,939, P < .001). Thirty-day readmission rates were also greater among body mass index ≥40 recipients (33.92% vs 26.9%, P < .01). Morbid obesity was not predictive of stay (odds ratio 1.01, P = .75). Conclusion Morbidly obese renal transplant recipients incur greater costs and readmission rates compared with nonobese patients. Recognition of increased resource utilization should be accompanied by appropriate, risk-adjustment reimbursement.

Laparoscopic sleeve gastrectomy improves renal transplant candidacy and posttransplant outcomes in morbidly obese patients

“…First, morbidly obese recipients have significantly higher readmission rates, resulting in greater resource utilization. 21 These patients also have alarmingly high rates of wound complications after kidney transplantation, ranging from 15-44%, 3,22,23 which further increases posttransplantation readmission rates. 24 Our Second, pretransplantation morbid obesity is an important risk factor for the development of NODAT.…”

“…21 These patients also have alarmingly high rates of wound complications after kidney transplantation, ranging from 15-44%, 3,22,23 which further increases posttransplantation readmission rates. Three outcomes, in particular, substantiate this bias against morbidly obese candidates.…”

“…21,23,[30][31][32][33][34] Comparatively, the reported incidence of DGF among all recipients is estimated at 21%. 21,23,[30][31][32][33][34] Comparatively, the reported incidence of DGF among all recipients is estimated at 21%.…”

Addressing the challenges of sleeve gastrectomy in end-stage renal disease: Analysis of 100 consecutive renal failure patients

“…21 Obesity, metabolic syndrome, and DM all increase the risk of cardiovascular events and negatively impact wound healing after operative care. 28 In the current study, average patient pre-LSG BMI was 43.4 ± 5.9 kg/m 2 and median daily insulin …”

“…19 Second, treating obesity prior to RT may provide a means for reducing post-transplant resource utilization. 20,21 Third, whereas medical weight loss is unreliable, operative methods have emerged as an effective option for sustained, long-term weight loss. 22,23 One such method is the laparoscopic sleeve gastrectomy (LSG), which is approved by the American Society for Metabolic and Bariatric Surgery as a primary bariatric procedure.…”