Increased Surgery Risks in the Overweight and Obese

Overweight and obese people are at a higher risk for operative complications than individuals who have a healthy BMI (body mass index). Accurately assessing the risk of an operation for an overweight individual requires consideration of several issues that occur with greater frequency in this population. As an overweight patient preparing for surgery, you may expect your doctor to consider the following aspects of your health:

1. Obstructive sleep apnea

Overweight and obese patients are at increased risk for obstructive sleep apnea. Your physician may screen for this condition by asking you if you snore loudly or are always sleepy during the day.

2. Deep vein thrombosis and pulmonary embolism

Overweight individuals are at higher risk for deep vein thrombosis (DVTs). These are clots that develop in the lower extremities. A DVT can move up to the lungs and result in a potentially fatal pulmonary embolism (PE). If you have a personal or family history of blood clots your doctor may order preoperative coagulation studies.

3. Gallbladder disease

Gallstones and gallbladder disease occur more commonly in overweight or obese patients. This may, therefore, be an opportune time to undergo a concomitant cholecystectomy (gallbladder removal).

4. Diabetes

Type II diabetes mellitus is much more frequent in individuals who are overweight. Any individual with an above-average BMI should have their blood glucose tested before surgery.

5. Cardiovascular disease and heart failure

The risk for cardiovascular disease must be part of the preoperative evaluation in any obese patient. Your physician may consider obtaining an ECG before surgery, especially for intermediate- or high-risk procedures.

If your history or physical exam suggests heart failure your doctor may order a study to evaluate left ventricular function in patients. This is usually done with an echocardiogram.

6. Pregnancy complications and cesarean section

Increased maternal weight prolongs labor progression, so obese pregnant women and their obstetricians should be prepared for cesarean delivery.

Your doctor should also anticipate and try to prevent certain complications that are more common in obese pregnant women. These complications include:

Metabolic syndrome

Preeclampsia and hypertension

Urinary tract infection

Gestational diabetes

Post-term pregnancy and prolonged labor

Cesarean section

Emergent delivery

Postpartum hemorrhage

Postpartum cardiomyopathy

Chorioamnionitis

Endometritis

Forceps delivery and third- and fourth-degree perineal lacerations

Thromboembolism and PE

Failed epidural

Failed intubation and difficult airway

Gastroparesis and aspiration

Obviously, there are many different areas of increased risk in the overweight or obese individual who is planning to undergo surgery. You should discuss each of the pertinent areas of risk with your doctor and, ideally, lose weight prior to your operation.