Clinicians need to be aware of the problems associated with obesity and surgery says a new review published today in The Obstetrician & Gynaecologist (TOG).
As the overall incidence of obesity is on the rise, the risk of surgical complications also increases.
A BMI of more than 30 indicates obesity, however, the principal concern in surgical practice is for people with a BMI of more than 40 (morbid obesity), as this has additional risks in itself.
Many gynaecological conditions can be treated without surgery and weight loss alone will improve conditions such as stress incontinence.
Conservative therapies, such as bladder retraining and physiotherapy for urinary problems; and pessaries for prolapse, should readily be considered for women who are obese says the review.
If surgery is required, the review states that obese women should receive counselling about the increased risk of complications and technical difficulties that may be encountered.
In preparation for surgery, preoperative evaluation including a cardiovascular and respiratory history and relevant examination is needed. In each case, weight and height should be recorded and the BMI calculated and clearly documented in the notes.
The possible risks from surgery include: infection, bleeding, organ damage, thromboembolism and surgical difficulty. In addition there can be anaesthetic problems which include: airway and ventilation problems, nausea and issues with lifting and moving the patient. The review notes that induction of anaesthesia and preparation for surgery will take extra time.
The review recommends that all staff should undergo appropriate manual handling training. It also says that every operating table, trolley and bed should be labelled with its maximum weight capacity and that special hospital beds should be available that can accommodate the weight and enable movement of the patient.
During open surgery, obesity presents problems as there is an increased risk of wound infection and wound failure.
Departmental protocols and guidelines in the management of obese people are important, as is
the adequate training of staff involved in their care.
Patrick Hogston, Consultant Gynaecologist, Queen Alexandra Hospital, Portsmouth, said:
"All gynaecologists involved in surgery for obese women should be aware of the potential problems involved.
"Individual units should have a clear pathway of care and guidelines for the management of obese women and doctors should discuss with the patient the benefits and risks of the procedure and involve her in decision making."
TOG's Editor -in-Chief, Jason Waugh said:
"Obesity is an increasing problem. It is essential that staff involved in treating obese patients are fully trained and that there are departmental protocols and guidelines in place to advise on the management of these patients."
Reference
Biswas N, Hogston P. Surgical risk from obesity in gynaecology. The Obstetrician & Gynaecologist 2011;13:87-91.
As the overall incidence of obesity is on the rise, the risk of surgical complications also increases.
A BMI of more than 30 indicates obesity, however, the principal concern in surgical practice is for people with a BMI of more than 40 (morbid obesity), as this has additional risks in itself.
Many gynaecological conditions can be treated without surgery and weight loss alone will improve conditions such as stress incontinence.
Conservative therapies, such as bladder retraining and physiotherapy for urinary problems; and pessaries for prolapse, should readily be considered for women who are obese says the review.
If surgery is required, the review states that obese women should receive counselling about the increased risk of complications and technical difficulties that may be encountered.
In preparation for surgery, preoperative evaluation including a cardiovascular and respiratory history and relevant examination is needed. In each case, weight and height should be recorded and the BMI calculated and clearly documented in the notes.
The possible risks from surgery include: infection, bleeding, organ damage, thromboembolism and surgical difficulty. In addition there can be anaesthetic problems which include: airway and ventilation problems, nausea and issues with lifting and moving the patient. The review notes that induction of anaesthesia and preparation for surgery will take extra time.
The review recommends that all staff should undergo appropriate manual handling training. It also says that every operating table, trolley and bed should be labelled with its maximum weight capacity and that special hospital beds should be available that can accommodate the weight and enable movement of the patient.
During open surgery, obesity presents problems as there is an increased risk of wound infection and wound failure.
Departmental protocols and guidelines in the management of obese people are important, as is
the adequate training of staff involved in their care.
Patrick Hogston, Consultant Gynaecologist, Queen Alexandra Hospital, Portsmouth, said:
"All gynaecologists involved in surgery for obese women should be aware of the potential problems involved.
"Individual units should have a clear pathway of care and guidelines for the management of obese women and doctors should discuss with the patient the benefits and risks of the procedure and involve her in decision making."
TOG's Editor -in-Chief, Jason Waugh said:
"Obesity is an increasing problem. It is essential that staff involved in treating obese patients are fully trained and that there are departmental protocols and guidelines in place to advise on the management of these patients."
Reference
Biswas N, Hogston P. Surgical risk from obesity in gynaecology. The Obstetrician & Gynaecologist 2011;13:87-91.
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