The Effect of BMI and the Obesity Paradox on Post-PCI Healthcare Costs and Length of Stay

OBJECTIVES: Coronary artery disease (CAD) is one of the leading causes of death, and 900,000 percutaneous coronary interventions (PCIs) are performed each year in the US. While BMI is known to affect PCI morbidity and mortality, overweight individuals have better outcomes compared to normal individuals in the obesity paradox phenomenon. Our study aimed to analyze whether this paradox translates to increases in healthcare costs and hospital length of stay (LOS) among adult post-PCI populations.

METHODS: Adult patients (≥18 years old) with an inpatient encounter and PCI procedure from 2016-2019 were selected from the Healthcare Cost and Utilization Project (HCUP) national database. Patients were classified by BMI: <19.9, 20-29, 30-39, and >40. Descriptive results for LOS and healthcare costs are reported.

RESULTS: Among 74,696 patients, the study’s BMI distribution was representative of the national distribution (<19.9: n=2,284, 20-29: n=8,521, 30-39: n=42,617, >40: n=21,274). Patients with BMIs <19.9, 20-29, 30-39, and >40 reported a mean (SD) LOS of 8.2 (9.1), 5.2 (6.3), 3.7 (4.2), and 4.6 (5.4) days, respectively. Costs [mean (SD)] followed a similar trend, where patients with BMI <19.9 reported the highest costs, and patients with BMI 30-39 reported the lowest costs [BMI <19: $38,601.90 ($44,686); BMI 20-29: $30,025.50 ($25,633); BMI 30-39: $25,388.40 ($18,502); BMI >40: $27,597.90 ($23,382)].

CONCLUSIONS: Overall, the two lowest BMI groups had the highest costs and longest LOS and thus indicating a potential positive link between overweight BMI and both outcomes. These results align with the growing body of evidence on the obesity paradox among patients with CAD, suggesting that higher BMIs may indicate a reduced risk of adverse outcomes.