Pre-pregnancy BMI: costs associated with maternal underweight and obesity in Queensland.

BACKGROUND: The economic costs of maternal obesity and underweight have not been described. We aim to assess the effect of maternal underweight and obesity on hospital utilisation and hospital costs. METHODS: Data from the Queensland Perinatal Data Collection and Queensland Hospital Admitted Patient Data Collection were analysed for 2008. The sample included 37,912 Queensland resident mothers with a singleton pregnancy who gave birth in a public facility. Outcome measures were hospital length of stay (LOS) and hospital costs accrued during the birth admission and during pre- and postnatal admissions within 90 days of the birth admission. RESULTS: There were 1,581 (4.2%) underweight, 17,175 (45.3%) normal weight, 10,155 (26.8%) overweight and 9,001 (23.7%) obese women. Maternal obesity was associated with significantly longer stays although effect sizes were modest (≤0.5 days) and specific to women who delivered vaginally. LOS was significantly higher among babies born to underweight mothers when compared to those born to normal weight women. Maternal obesity was associated with a total increase of $5 million in mothers' hospital costs when compared to those amongst normal weight women; the corresponding figure for underweight mothers was $385,734. The total hospital costs for babies born to underweight women were $1.6 million higher than those born to mothers in the normal weight category. Maternal obesity was not associated with an increase in babies' hospital costs. CONCLUSIONS: Maternal obesity contributed to an increase in mothers' hospital LOS and hospitalisation costs. Maternal underweight contributed to an increase in babies' hospital costs.

Paradox of meritocracy in surgical selection, and of variation in the attractiveness of individual specialties: to what extent are women still disadvantaged?

BACKGROUND: Evidence from outside surgery suggests that meritocracy-based processes around selection tend to reduce, rather than increase, diversity. In recent years, the surgical training boards have gone to considerable effort to achieve greater transparency and fairness in their selection processes, and to identify those attributes that are believed to best predict future success as a surgeon. This is consistent with the Royal Australasian College of Surgeons Diversity and Inclusion Plan, which places emphasis on gender equity and has goals that include increasing the attractiveness of surgery as a vocation for women, removing impediments to them applying to the surgical training programmes and removing any biases that might disadvantage them during the selection process. METHODS: This study uses the Female Opportunity Index and rate ratio metrics to measure the level of female disadvantage in surgical selection, whether it be by the perception of its attractiveness to women which influences their application rates, or by the likelihood of successful selection for those who have applied, compared with their male counterparts. RESULTS: There are marked differences between the nine surgical specialties and 13 specialty training boards in both the proportion of women who apply, and the proportion who are successful in gaining entry onto the Surgical Education and Training programmes. The Female Opportunity Index ranged from 0.21 to 0.87, which represents a wide variation between surgical specialties. CONCLUSION: These data raise the question as to whether unconscious bias is occurring in an apparently meritocracy-based selection process in some specialties. The data also suggest that some specialties are relatively unattractive to women, for which the reasons are likely to be complex.