Obesity Increases Risks During Surgery
Healthcare providers must carefully consider the unique risks related to severe obesity in patients undergoing all types of surgery, according to the American Heart Association.
"A severely obese patient can be technically difficult to evaluate prior to surgery," Dr. Paul Poirier was quoted as saying. Paul Poirier, M.D., Ph.D., is the lead author of the advisory and associate professor at Université Laval Institut universitaire de cardiologie et de pneumologie Hôpital Laval in Québec, Canada.
Severe obesity describes people with a body mass index (BMI) of 40 or higher. This type of obesity affects 3 to 4 percent of the population. "In the obese population,” the authors write, “the severely obese make up the fastest growing segment."
The advisory provides pre-operative evaluation recommendations, along with information on managing and caring for obese patients during and after surgery. Conditions associated with obesity that could increase risks in surgery include heart failure, atherosclerosis (thickened or narrowed arteries), high blood pressure, heart rhythm disorders, history of blood clots (especially pulmonary embolism), poor exercise capacity and pulmonary hypertension related to sleep apnea.
The clinician should consider age, gender, cardio-respiratory fitness, electrolyte disorders and heart failure as independent predictors for death or complications from surgery, according to the advisory.
The advisory proposes a scoring tool to assess risk for patients preparing to have weight-loss surgery, and the advisory suggests additional research is needed to develop obesity risk scores for patients contemplating other types of surgery.
Severely obese people should ask their surgeons whether a particular surgery is safe for a patient their size. The authors caution,
"Since recovery can be a problem for these patients, we recommend that they take steps to be as healthy as possible before going into surgery."
SOURCE: Circulation: Journal of the American Heart Association, June 15, 2009