Medical costs were 22 percent higher for overweight patients who presented at an emergency department with chest complaints compared with normal weight patients, and 41 percent higher for morbidly obese patients, researchers reported online March 4 in Circulation: Cardiovascular Quality and Outcomes. The findings also hinted at possible unnecessary imaging in the morbidly obese.

Senior author Jeffrey A. Kline, MD, of the Indiana School of Medicine in Indianapolis, and colleagues conducted a secondary analysis of a four-center prospective study to test whether body mass index (BMI) was a predictor of costs in patients with chest pain and shortness of breath who present at the emergency department. They enrolled 829 adult patients with chest pain and dyspnea with no obvious diagnosis who required diagnostic testing.

Patients were categorized by weight (underweight, with a BMI of less than 18.5; normal weight, BMI of 18.5 to less than 25; overweight, BMI of 25 to less than 30; obese, BMI of 30 to less than 40; and morbidly obese, BMI of more than 40).

Kline et al measured length of stay, medical costs and radiation exposure stratified by weight category. Outcomes were assessed at 90 days through telephone follow-up. Outcomes included the percentage of patients with a significant cardiopulmonary diagnosis and the percentage of patients who had a CT pulmonary angiogram with no significant diagnosis.

They found that length of stay increased with weight category, with overweight, obese and morbidly obese patients about 10 percent more likely to be admitted to the hospital than normal weight patients. Morbidly obese patients who did not receive a CT scan remained in the hospital 34 percent longer than normal weight patients who never underwent a scan, and morbidly obese patients who had one or more scans remained 44 percent longer than normal weight patients who didn’t have a scan.

Morbidly obese patients had the highest frequency of no significant cardiopulmonary diagnosis after a CT scan of all the weight categories, at 87 percent compared with 81 percent of the normal weight patients.   

Compared with normal weight patients, costs for overweight, obese and morbidly obese patients were 22 percent, 28 percent and 41 percent higher. Costs for underweight patients were 2 percent lower, but the result was not statistically significant.

Radiation dose was not significantly different in the various weight categories and weight category was not a significant predictor of radiation exposure.

“Morbid obesity with CT scanning and morbid obesity without CT scanning were both associated with increased length of stay,” they wrote. “Morbidly obese patients also had a higher rate of no significant cardiopulmonary diagnosis for 90 days after CT pulmonary angiography, which some may interpret as a higher rate of unnecessary imaging.”

The findings may help service line directors, administrators and physicians who practice where obesity is prevalent plan for resource use and develop weight-specific protocols, they proposed. The findings also may indicate physicians need to be better educated about options to avoid unnecessary CT imaging.