Collective ReviewsThe Impact of Obesity on Surgical Outcomes: A Review
Section snippets
Definition and Scope of Problem
Obesity, an excess in body fat contributing to comorbidity, is the most prevalent chronic disease in the United States today. A review by the National Center for Health Statistics (NCHS) between 1976 and 1980 found 26% of the adult population in the United States to be overweight [1]. This group comprised 34 million people, 13 million of whom were severely overweight. A followup study conducted between 1988 and 1991 showed an increase in the prevalence of overweight to 33.4% of US adults [2].
Anesthetic Risks and Complications
Potential problems related to airway control are of major concern to anesthesiologists when confronted with the need to provide general anesthesia to obese patients. Obese patients often have short, thick necks and heavy chest walls that make standard orotracheal or nasotracheal intubation and ventilation difficult. Fiberoptic bronchoscopy, with cannulation over the bronchoscope, is occasionally required to facilitate tracheal intubation. Arterial and venous access may be difficult because of
Elective Surgical Procedures
The results of a variety of elective abdominal procedures in obese patients have been studied with specific reference to outcomes. Prem and associates [12]reviewed mortality in women undergoing hysterectomy for endometrial carcinoma from 1939 through 1963. There appeared to be an increase in mortality with increasing weight, but the number of patients weighing > 300 lb was small. There was one death in five patients (20%) weighing > 300 lb, compared with one death in 18 women (5.5%) between 250
Risks Associated With Pregnancy
Numerous reviews have been published dealing with the risk of pregnancy in obese women, and a growing body of literature is emerging that focuses on the relationship between obesity and infertility. In studies of women presenting for evaluation or treatment of infertility, the incidence of obesity varies between 8.7% [56]and 25% [57], with increased numbers of obese patients noted in the groups experiencing anovulation. Hamilton-Fairley and associates [57]documented fewer ovulatory cycles in
Cardiovascular Risk
A loss of sensitivity to insulin appears to be the initial metabolic defect in obesity [69]. The resultant insulin resistance and hyperinsulinemia predispose the obese patient to many of the obesity-related comorbid conditions. The association is so strong that the constellation of obesity, hypertension, hyperlipidemia, and type II diabetes mellitus has been termed syndrome X [70]. Each of the disorders associated with syndrome X can independently affect cardiac function. Even in the absence of
Summary
Obese patients are at increased risk for numerous medical problems that can adversely affect surgical outcomes. These risks have not uniformly translated into increased or prohibitive operative morbidity and mortality in this population. With appropriate perioperative precautions and monitoring, the incidence of serious cardiovascular and pulmonary complications can be minimized. Obese patients can be treated as safely and effectively as their normal-weight counterparts under most circumstances
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