Super obese patients are at particular risk for poor outcomes after ambulatory surgery. (Image source: Thinkstock)

Super obese patients are at particular risk for poor outcomes after ambulatory surgery. (Image source: Thinkstock)

The population in the United States is getting heavier.  It follows that patients undergoing ambulatory surgery are also heavier than in the past.  What should the practicing anesthesiologist caring for obese patients know in terms of patient selection to be an ambulatory patient?

Dr. Girish P. Joshi, MB BS, MD, FFARSCI, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX and coauthors analyzed data from 25 studies that included over 100,000 patients to help ascertain how it can be determined whether it is appropriate for an obese patient to undergo ambulatory surgery.  Their findings are presented in the manuscript “Selection of Obese Patients Undergoing Ambulatory Surgery: A Systematic Review of the Literature” published in this month’s issue of Anesthesia & Analgesia.

Hospital admission rates were similar for obese and nonobese patients. The super obese (BMI > 50 kg/m2) had more comorbidities and longer operating times based on the results of a study that used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to compare 30-day morbidity and mortality rates in super obese and morbidly obese (BMI = 40-49 kg/m2) patients undergoing laparoscopic bariatric procedures.  Patients who were super obese also had a higher incidence of superficial and deep wound infections, sepsis, septic shock and 30-day mortality.  Morbidly obese patients from other studies had more wound and urinary tract infections, higher 30-day readmission rates and increased mortality.  Such factors as symptomatic asthma, gastroesophageal reflux disease, obstructive sleep apnea and a history of deep vein thrombosis or pulmonary embolisms influenced readmission rates after discharge home.

Though there has been much discussion about patient selection for obese patients, this study demonstrates, perhaps as expected, that our concern should be focused on super obese patients.

As indicated by the authors, more research is needed.

OpenAnesthesia has a discussion of outpatient vs. inpatient surgery.