A recently released toolkit contains new, evidence-based guidelines to inform surgical considerations for obese patients.1

Issued by the Accreditation Association for Ambulatory Health Care (AAAHC) in January, the six-page trifold includes a flowchart with guidance on body mass index (BMI), sedation levels, and pre-existing conditions.

One section is called “Preoperative and Intraoperative Considerations.” It mentions the Society of Anesthesia and Sleep Medicine guidelines that are relevant to obstructive sleep apnea (OSA) and obese patients:

  • “Known or suspected OSA should be considered an independent risk factor for difficult intubation, difficult mask ventilation, or both. Providers should take adequate difficult airway management precautions.”
  • “Patients with OSA may be at increased risk for adverse respiratory events from the use of propofol or other medications for procedural sedation.”
  • “When applicable, regional anesthesia is preferable over general anesthesia in patients with OSA.”

It is important to identify OSA before surgery. While recovering and managing pain with medication, these patients should use their CPAP devices more often, even if they are napping during the day.

There are multiple other comorbidities surgeons must consider when treating obese patients, including diabetes, hypertension, sepsis, and renal insufficiency. For obese patients with diabetes and renal insufficiency, wounds might heal slower. This can cause problems such as sepsis. A key change in 2021 is the inclusion of a section about COVID-19 and its potential effects on obese patients. “The effects of COVID are becoming more and more known, and there are long-term effects that involve more than the respiratory system,” says Cheryl Pistone, RN, MA, MBA, clinical director at AAAHC. “[COVID-19] can affect the heart, liver, kidney, brain, and endocrine system.”

When surgery centers provide care to an obese patient who has recovered from COVID-19, they are more likely to experience complications because of their weight and the infectious disease. “Beware of clotting and impaired organ function if they had COVID,” Pistone notes.

There can be additional risks when treating obese patients, but surgeons can operate on these patients safely by following proper guidelines. “You have to decide on that continuum of which patients are safe for surgery in this environment and which are not,” Pistone explains. “As we do more orthopedic procedures in ambulatory surgery centers, I think we’ll see more obese patients.”

REFERENCE

  1. Accreditation Association for Ambulatory Health Care. Ambulatory procedure considerations for obese patients (2021).