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Background Current trends estimate a 33% increase in obesity and 130% increase in severe obesity by the year 2030. It is unclear what the effect of obesity is on postoperative fevers, postoperative complications, and diagnostic workup rates. Methods We evaluated 5,330 patients undergoing knee arthroplasty, colectomy, or craniectomy from October 2009 to December 2014 at NorthShore University HealthSystem, in Illinois. Clinical data were extracted from the Enterprise Data Warehouse, including diagnostic testing and complications. Complications were also verified by physician chart review. Χ2 and Mann–Whitney U tests were used to analyze categorical and continuous variables. Results Obesity (BMI ≥ 35) was present in 1081 (23.4%) of knee arthroplasty, 38 (16.9%) of colectomy and 55 (12.6%) of craniectomy patients. There was no increase in complications by BMI in each individual surgery except for increased 30-day readmissions in craniectomy patients with BMI ≥ 35 (P = 0.032). Collectively, there was no difference in the relationship between BMI and rate of post-op complications (Table 1). However, patients with BMI ≥ 35 experienced more fevers (P = 0.002), underwent additional workup (0.011), and had higher workup costs (P < 0.001). Conclusion Patients with BMI ≥ 35 had more fevers, more workups and higher cost, but not higher complication rates during the index hospitalization after surgery. Awareness of the predisposition towards post-op fever in obese patients in the absence of complication may prevent costly and unnecessary testing. More work is still needed to understand the effect of obesity on more distant complication rates. Table 1: Post-Surgical Characteristics, Stratified by BMI BMI < 35 kg/m2, N = 4,156 BMI ≥ 35 kg/m2, N = 1,174 P-value Surgery Knee arthroplasty 3533 (85%) 1081 (92.1%) <0.001 Colectomy 187 (4.5%) 38 (3.2%) Craniectomy 436 (10.5%) 55 (4.7%) Fever ≥100.4 696 (16.7%) 242 (20.6%) 0.002 Fever ≥ 101 329 (7.9%) 125 (10.6%) 0.003 Any Work-Up 2409 (58%) 729 (62.1%) 0.011 Any in-hospital complication 341 (8.2%) 86 (7.3%) 0.327 Median work-up costs, dollars (IQR) 51,038 (46656–57436) 52,697 (48644–58517) <0.001 Median length of stay, days (IQR) 3.0 (2.0–3.0) 3 (2.0–3.0) 0.524 30 days Readmission 184 (4.4%) 53 (4.5%) 0.898 Death w/in 30 days 12 (0.3%) 3 (0.3%) 0.754 Disclosures All authors: No reported disclosures.

Weighing in: Effect of BMI on Postoperative Fever and Complications in Patients Undergoing Three Distinct Surgeries