Comparison of Early Postoperative Outcomes and Reimbursement Metrics in Obese Versus Nonobese Patients Undergoing Secondary Reconstruction for Achilles Tendinopathy.

Abstract

This study aims to evaluate whether obesity affects early postoperative outcomes or reimbursement metrics following surgical intervention for Achilles tendinopathy. A retrospective analysis was done using the National Surgical Quality Improvement Program database (2013 to 2022). Patients undergoing secondary Achilles reconstruction were identified through Current Procedural Terminology and International Classification of Diseases 9th/10th codes and were categorized as obese (body mass index ≥ 30) or nonobese (body mass index < 30). Demographic variables, comorbidities, 30-day postoperative complications, including mortality, readmission, revision surgery, wound complications, thromboembolic events, respiratory complications, infectious complications, renal complications, cardiac complications, and transfusion. The number of concurrent procedures and work relative value unit (wRVU)-based compensation metrics were compared between the two groups. An analysis of covariance was done to adjust the effect of patient demographics, preoperative comorbidities, and perioperative complications on the valuation of compensation metrics. Six hundred eighty-eight patients met inclusion criteria: 505 (73.4%) were obese and 183 (26.6%) were nonobese. Obese patients had markedly higher rates of comorbidities, including diabetes and hypertension. No notable differences were found between the two groups in any of the early postoperative complication rates we investigated. The number of concurrent procedures per case was markedly higher in the obese group: 1.2 vs. 1.0, P = 0.015. Regarding compensation metrics, wRVU/hr, and reimbursement ($/hr) were comparable between the groups after analysis of covariance: 14.6 wRVU/hr and 473.82 $/hr for the obese group versus 13.5 and 435.2 for the nonobese group, P = 0.131, respectively. Our findings suggest that secondary reconstruction for Achilles tendinopathy can be done safely in obese patients without increasing short-term postoperative complication rates. Compensation metrics remained comparable between the obese and nonobese groups, indicating that the increased preoperative burden and surgical demands in obese patients may not be matched by a proportional increase in reimbursement. Level III.