Severe obesity increases risks of health problems during surgery

Thursday 18th June 2009 HCFI New Delhi:  Many doctors 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.

However doctors must carefully consider the unique risk factors related to severe obesity in patients undergoing all types of surgery, said Dr KK Aggarwal President Heart Care Foundation of India and Director IMAAKN Sinha Institute.  According to an American Heart Association scientific advisory published in Circulation: Journal of the American Heart Association, severe obesity can pose special challenges, including cardiac risks, in patients undergoing surgery; doctors must carefully evaluate those risks and not underestimate them.  The risk of a cardiac event before, during or after surgery in obese patients is related to the type and severity of their heart’s condition, as well as other health conditions and the type of surgery they are having. Severely obese patients are at higher risk than non-obese patients for complications after surgery and for prolonged hospital stays; however, they are not at higher risk for death.

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. Severe obesity describes people with a body mass index (BMI) of 40 or higher. This type of obesity, affecting 3 percent to 4 percent of the population, is associated with health problems that may lead to disability and death.

Conditions associated with obesity that could increase heart 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
• Pulmonary hypertension related to sleep apnea

Severely obese patients are more likely to stay on a ventilator longer and have a longer hospital stay than patients who are not severely obese.