TL;DR Operating on obese patients is dangerous
Copied from a Reddit post
Doctor here, specifically I’m an anaesthetist. I thought I would share a bit of info about how obesity and being overweight impact on my ability to get these patients through surgery safely.
Obese patients are the bane of my life. In every way they are more difficult to anaesthetise and operate on. They have more problems while being put to sleep, during the surgery and in recovery afterwards. I’m going to explain exactly why these patients are more difficult to manage.
Before a patient comes for an elective surgery they are seen by either an anaesthetist or a specially trained nurse to assess their risk of having problems. When an obese patient walks in I internally start to get jumpy. I always treat patients with respect and kindness. They are often very worried about surgery. I have to explain to obese patients that they have a much higher risk of complications, which understandably they don’t take well. I have had to sit through some serious fat logic at times. I’ll share some specific stories if people would like. My colleagues and I then have to make the difficult decision on whether these guys are fit for surgery. It’s not an easy call a lot of the time, especially when the surgery is something they have been waiting a long time for or is for something that is having a big impact on their lives. We want to do our best for people and get them to their surgery if at all possible. It’s heart breaking for me when I have to tell a patient they can’t have their surgery as it would be too risky and that they can try to lose weight and come back in 6 months.
Once the patients actually get to the operating theatre the real problems start. If the patient is particularly heavy we need to get swap the ordinary operating table out for a more robust version. We need to divert extra staff from other areas to help with moving and positioning the patient.
The first problem we often come across is inserting an IV line. It’s simply very difficult to find veins when they are buried under inches of fat. I remember one occasion when I had to actually cancel and reschedule an operation because my self and two senior consultant anaesthetists could simply not get venous access after literally dozens of attempts. When you give the patients the ‘sleepy’ drugs you then have to manage the patients airway and breath for them. You have to hold the patient’s airway open and with the large heavy necks that these patients have this can be physically very difficult. Intubating these patients is much more difficult. The weight of the extra tissue in their necks means their airways collapse (the same reason they get sleep apnoea) and you can’t see the opening of the trachea to insert the tube. This is obviously dangerous for the patient. We have to use difficult airway equipment far more often.
Obese patients are much harder to ventilate due to the heavy weight of their chests. We have to use high pressures to force their lungs open. This can damage their lungs and slow their recovery. It also really increases the chance of them having breathing trouble when they wake up.
Undergoing a general anaesthetic and operation puts strain on the hearts of the healthiest patients. Obviously in the obese patient they have a much higher risk of heart and artery problems to begin with. They have a much higher risk of having a heart attack while asleep than a patient of normal size. They may also be unable to sustain their blood pressure while anaesthetised and need a bucket load of extra heart stimulating drugs to keep them ticking over. Simple things like taking the patients blood pressure are more difficult as a) the cuffs may not fit properly round their arms and b) the readings are less accurate anyway as they are being measured through a thick layer of fat.
Diabetes is another major problem. I’m responsible for their blood sugar during surgery and the stress of being operated on throws their sugars up the left. This can be really dangerous and it’s just another thing I have to keep on top of that I wouldn’t normally have to even consider.
The risks of an anaesthetic increase with the length of the surgery. Operations last longer in an obese patient due to all the extra tissue the surgeon has to wade through and then stitch up.
Obese patients are at a much higher risk of having a blood clot. A DVT is more likely during surgery due to the patient lying still for an extended period and the stress hormone overdrive. A clot can be fatal if it moves to the lungs. We have to load the patients up with more anti clotting drugs which makes the risk of bleeding post op more likely.
All in all it’s a complete nightmare. We always do our best but our jobs are so much harder when dealing with obese patients. I’m worried the entire time and it is not rare for things to go badly wrong. I know if I were overweight and needed surgery id be even more terrified than I would be normally.”