Operating on the Obese: What can go Wrong

Dr Jaime Beit is director of anaesthesia at Toowoomba Hospital in the Darling Downs, west of Brisbane - one of ...

Dr Jaime Beit is director of anaesthesia at Toowoomba Hospital in the Darling Downs, west of Brisbane – one of Australia’s heaviest regions.

Some days, every patient on Dr Jamie Beit’s theatre list weighs more than 100 kilograms.​

Beit is director of anaesthesia at Toowoomba Hospital in the Darling Downs, west of Brisbane – one of Australia’s heaviest regions.

In a place where nine in every 10 of the hospital’s patients are overweight or obese and “normal” is a body mass index of 32, there are much greater risks associated with operating, Beit said.

Obese patients require more careful attention and often have greater risks of complication in surgery.

Sometimes  that meant not going ahead with a procedure.

“If you have a very high BMI and type 2 diabetes and you’re having a knee replacement, your chances of getting a wound infection are very high.

“For some patients you say ‘for you at this particular time, it may be better for you to not have anything, than have this operation’.”

To measure the extent of the issue in Toowoomba, Beit’s hospital took a snapshot of 250 elective surgery patients aged 18 and over.

Just 10 per cent of female patients and 22 per cent of males were in the healthy weight range. Two thirds of women were classified as obese and 23 per cent class 3 obese.

Beit shared his findings with other medical professionals from around the world at the annual scientific meeting of the Australian and New Zealand College of Anaesthetists (ANZCA) in Sydney on Wednesday.

New Zealand was grappling with the same issues, Dr Nigel Robertson specialist anaesthetist at Auckland City Hospital said.

We’re the third fattest in the OECD, with 30 per cent of our adults classified as obese.

Obese is defined as a BMI of 30 or higher, and morbidly obese or class 3 obese is 40 or more.

“We’ve got operating room tables now rated for 450 kilograms rather than 250kg,” Robertson said.

That really meant they were designed to take 200kg patients at funny angles, he said.

“It’s not worth buying the ones with a lighter rating anymore, because you can’t put anybody on them.”

Table extensions, ramping pillows and wide wheelchairs were commonplace.

Patients weighing about 150kg could be a daily occurrence in theatre, he said. “It’s not unusual to get up to 200kg.

“That’s not to say they’re all sick, but there are still issues around keeping them safe while they’re being operated on.”

Positioning, managing airways, inserting breathing tubes and sedating patients could all become more complicated among obese patients, Robertson said.

“They’re difficult to nurse, they’re difficult to position, they can get pressure sores, it takes more work to get lures in, to get them on and off the bed …

“There’s a whole cascade of complications that fall out.”

There’s also a greater risk of wound infection post-surgery, due to things such as poor blood supply to the wound or immobility, he said.

Robertson, who specialises in neuroanaesthesia, recalled the stress he felt working on a 190kg man for a neurological procedure.

“He didn’t bat an eyelid. I was sweating buckets trying to position this enormous person and trying to get him through this anaesthetic, but it was fine because he was otherwise fit and well.”

“We’re getting more used to it, so it’s not nearly as stressful as it used to be.”

Although it can be frustrating, Robertson said it was important to not project that frustration on to the patient.

“You have to do your best, and you have to treat people with empathy and care and the best evidence.

“I think we now understand the consequences of obesity,  so we have a better toolkit to deal with it.”

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