The Effect of Body Mass Index on the Outcome of Critically Ill Surgical Patients

Background: The incidence of obesity is rising, and an increasing number of obese patients are admitted to surgical intensive care units (SICUs). However, it is not clear whether obesity is an independent risk factor for increased morbidity and mortality in SICU patients. We examined the effect of obesity on morbidity and mortality in patients admitted to the SICU in this study. Method: We reviewed prospectively acquired SICU data in normal and obese patients with an SICU length of stay >24 hours. Comparability of the groups was assessed using a χ² test or Fisher exact test, as appropriate, for categorical variables and analysis of variance (ANOVA) or the Kruskal‐Wallis test, as appropriate, for continuous variables. Results: Of the 1792 consecutive patients evaluated, 711 had a normal body mass index (BMI), and 993 were either preobese or obese. There was no statistically significant difference across the 5 BMI groups with respect to any of the 3 comorbidity indices (Acute Physiology and Chronic Health Evaluation III [APACHE III], Simplified Acute Physiology Score, or Multiple Organ Dysfunction Score). There was no statistically significant difference in the intensive care unit (ICU) length of stay and hospital length of stay or time‐to‐ICU mortality (log‐rank test P = .054) among the 5 BMI groups. A Cox regression analysis and backward elimination algorithm selected APACHE III to be the most important explanatory variable for survival time. Conclusion: Obesity does not affect the mortality of patients admitted to the SICU. We conclude that obesity cannot be used as an independent predictive mortality outcome variable in patients admitted to the SICU.     

A review of the Office of Inspector General's reports on adverse event identification and reporting

The Office of Inspector General published a series of four reports from 2008 to 2010 after investigating the frequency and financial impact of “never events” on Medicare recipients. This series investigated healthcare's ability to identify the occurrence of these events and yielded a detailed analysis of data that must, or at least should, be reviewed to fully understand the clinical risks affecting organizations. These reports also shed light on the reality that there remains gross underreporting of adverse events in healthcare and begs several questions about healthcare's current efforts to fully identify and understand risk. This article summarizes the reports and considers their risk management implications, particularly regarding adverse events.     

Viewing the candidates as risk managers

After one of the most chaotic political primary seasons that we've seen in many years, election season began early this time around. It promises to be one of the most entertaining in decades as we head towards the respective national conventions in late summer. The candidates are touting “change” as one of the central themes for their campaigns, but I must say that a more appropriate word might be “choice.” I doubt that there has ever been a more diverse field of candidates.