Increased 90-Day Episode-of-Care Costs Associated With Severe Obesity in Lumbar Decompression Surgery

A national retrospective observational cohort study was conducted using the MarketScan Commercial Claims and Encounters and MarketScan Medicare Supplemental and Coordination of Benefits databases (Merative). This study aimed to compare 90-day episode-of-care costs and outcomes between patients with and without severe obesity undergoing lumbar decompression (LD). Severe obesity is associated with longer hospital stays and increased postoperative complications after lumbar spine surgery; however, its impact on episode-of-care costs remains underexplored. Patients who underwent single-level LD between January 2018 and October 2023 were identified. Patients were stratified by a severe obesity diagnosis. The primary outcome was the cost for the day of surgery, 30-day, and 90-day episodes of care. Secondary outcomes included complication, readmission, and reoperation rates. A total of 56,897 patients undergoing LD were included, of which 5.6% were diagnosed with severe obesity. These patients demonstrated higher rates of readmission, emergency department visits, 30-day and 90-day complications, and reoperation (P&#xa0;<&#xa0;0.001). Day-of-surgery costs were higher in these patients ($26,993 vs. $22,279; P&#xa0;=&#xa0;0.001), as were total 30-day and 90-day episode-of-care costs ($30,316 vs. $24,551 and $34,569 vs. $27,816 for 30&#xa0;d and 90&#xa0;d, respectively, P&#xa0;<&#xa0;0.001). On multivariable analysis, severe obesity independently predicted increased day-of-surgery (P&#xa0;=&#xa0;0.013), 30-day (P&#xa0;<&#xa0;0.001), and 90-day total costs (P&#xa0;<&#xa0;0.001), as well as higher rates of any complication (OR=1.65, 95% CI=1.39-1.95), wound infection (OR=1.90, 95% CI=1.58-2.27), and wound disruption (OR=2.08, 95% CI=1.57-2.73). Severe obesity is associated with higher 30-day and 90-day episode-of-care costs following lumbar decompression surgery, driven by increased postoperative complications, readmissions, and reoperations. These findings highlight the need for both tailored management and adjusted reimbursement in this population, particularly in the setting of value-based care models.