Obesity and surgery

Obese patients and their doctors may face special challenges when undergoing and performing surgery. Health experts warn that health care provider should not underestimate the risks but on the other hand, should not dismiss obese patients as hopeless cases. The American Heart Association recently released a new Science Advisory on performing surgery on obese patients Let us look at  some of the issues surrounding obesity and surgery.

Proper evaluation is difficult in obese patients.

Performing an evaluation in highly obese patients can be difficult because of many co-existing conditions. Heart problems in particular are easily underestimated during a physical examination. According to lead author Dr. Paul Poirier,

“A severely obese patient can be technically difficult to evaluate prior to surgery. For example, severely obese people might feel chest tightness that could be a symptom of their obesity or of an underlying cardiac problem. Doctors need to carefully evaluate severely obese patients before they have surgery.”

Surgery can be difficult in obese patients.

Surgeons report that surgery can be challenging in severely obese patients. There was a big scandal in the UK a few years ago when some health care providers refused to perform surgery on obese patients

Obese patients are prone to complications.

Obese patients are more likely to suffer complications after surgery such as infections, and pulmonary embolism, and are more likely to stay on a ventilator and have a prolonged hospital stay.

Obese patients are not at higher risk for death.

Despite of these, the mortality rates during surgery do not depend on body mass index (BMI). According to Dr. Poirier

“Some surgeons are under the impression that severely obese patients are more likely to die in surgery than people who are not obese, and won’t operate on them as a result. This is not true. Severely obese patients are at increased risk for pulmonary embolism, wound infection and other conditions. But they are not more likely than their lower-weight counterparts to die as a result of surgery.”

The AHA advisory recommends the following:

• The recommendations are meant for all health care providers, from cardiologists, to surgeons, to anesthesiologists, providing pre-operative evaluation recommendations, as well as recommendations on management and care for obese patients during and after any type surgery, be it a knee replacement or a heart operation.
• The health care provider should especially pay attention to obesity-related conditions such as:
  • Heart failure
  • Atherosclerosis (thickened or narrowed arteries)
  • High blood pressure
  • Heart rhythm disorders
  • History of blood clots (especially pulmonary embolism)
  • Poor exercise capacity
  • Pulmonary hypertension related to sleep apnea
• The health providers should take into consideration age, gender, as well as the abovementioned conditions as independent factors for mortality or complication from surgery.
• Health care providers should advise patients to be as healthy as possible before surgery. This may include losing weight, keeping blood pressure under control (for those with hypertensiotn, or keeping blood sugar level under control (for those with diabetes).
• Extra, non-invasive tests may be performed if it aid in pre-surgery evaluation, such as ECG or chest X-ray.
• Surgeons should discuss with patients the risks associated with a particular surgery for a patient their size.

In providing this advisory, the AHA aims to give obese patients the best possible care they deserve.