Bariatric Times

SEP 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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12 Review and Case Study Bariatric Times • September 2017 a ssociated with bariatric pressure injury do not exist, the costs of pressure injury among the patient population without obesity do exist. According to Berlowitz et al, 29 m edical management of pressure injuries cost the United States healthcare system $9.1 to $11.6 billion per year. Individual hospitals spend about $5 billion annually to t reat pressure injuries. 3 0 A n acute hospital stay that involves pressure injury might incur additional charges of up to $700,000. Treatment costs for a Stage 3 p ressure injury can range from $5,900 to $14,840; treatment of a Stage 4 might cost between $18,300 and $21,410. 31 Falls can be another c onsequence of obesity. Mitchell et al 32 indicated that there were 31 percent more falls among hospitalized individuals with obesity. This is thought to be r elated to reduced peripheral sensation, polypharmacy, generalized physical weakness, or instability when standing or walking. Patakay et al 33 suggested t hat altered center of gravity associated with excess weight and weight maldistribution places the person with morbid obesity at risk for falls and, therefore, fall-related i njury. The deconditioned individual is at even greater risk. Some authors believe the risk of falling and fall- related injury seems to be more r elated to dynamic, rather than static elements. 34,35 This could be explained by the fact that there is no real reason that people with obesity should encounter a balance d isadvantage, as long as the center of gravity remains within the base of support, which is usually the case in a static situation. However, once the center of gravity falls o utside of the base of support, recovering balance might become more difficult than for individuals without obesity because of the greater body weight to be moved. 36 P atient-specific activity and mobility can be more challenging. In a study conducted by Rose et al, 37 the average time to stand and walk a patient with morbid obesity w as 99 minutes. Activities such as toileting, turning, and other patient care activities were significantly more time consuming. They contend the time-consuming nature o f bariatric care can lead to staffing challenges. 37 Each of these complexities are concerning, but collectively they serve to pose barriers to both economic and c linical efficiencies. ECONOMIC CONSIDERATIONS In addition to the general health consequences associated with issues of excess weight and weight maldistribution, economic consequences exist, and these economic costs can be profound. 3 8 For instance, in a meta-analysis that examined more than 60,000 admissions, there was increased ventilatory time and increased intensive care unity (ICU) length of stay among patients with a body mass index (BMI) greater than 30kg/m 2 . 39 When pressure injury occurs, the costs are compounded because of generalized tissue injury and time to heal. The same is true among individuals who sustain fall- related injury, pneumonia, or embolic conditions. 40,41 The length of stay in the general and acute care hospital can be prolonged and therefore costlier. 42 According to the McKinsey Global Institute, the global economic impact from obesity in 2014 was approximated at the equivalent of $2.0 trillion, or 2.8 percent of global Gross Domestic Product (GDP)—roughly equivalent to the global impact from smoking or armed violence, war, and terrorism. The United States spends an estimated $240 billion annually on obesity-related healthcare expenses, which include direct costs, such as outpatient and inpatient health services and drug therapy. Researchers from The University of Auckland announced the results of a 2012 study based on 2006 economic data, showing that costs associated with overweight and obesity in New Zealand range between $722 million and $849 million (NZD) a year in healthcare costs and lost productivity. 43 Other countries find a similar economic burden. 44 This economic burden is

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