Operative risks of obese patients: nursing care

Abstract

The obese surgical patient requires special care for his successful pre, intra, and postoperative management. Obese patients are at a disadvantage because of their more common tendency toward concomitant disease, relative immobility, infection, and pulmonary complications. We will discuss the increased operative risk of these patients and specific actions that can be taken by nurses to improve their operative and postoperative course. Preoperative considerations. Obesity is a common problem among adult Americans. Based on a study by the Society of Actuaries, over one-third of American men and women over 40 years of age are Overweight.' By definition, obesity designates a person with an abnormally high proportion of body fat relative to lean body mass. From a practical point of view, the most widely used criteria to assess obesity are height and weight tables. With an increased tendency toward concomitant disease, the obese patient has a decreased life expectancy. Men 20% or more overweight have an excess mortality of nearly 50% over nonobese control subjects, and with further increase in overweight, the excess mortality also increases. Conversely, if an obese patient loses weight to more normal levels, his mortality decreases. Therefore, it is wise to postpone elective surgery on an obese patient if it is reasonable to assume that the patient could lose excess weight in the interim. Obesity may lead to or exacerbate other systemic diseases. The most common diseases associated with obesity are cardiac disease, hypertension, renal and gallbladder disease, and diabetes mellitus. The heart usually enlarges, and the pulse rate, cardiac output, stroke volume, and blood volume may all increase causing an increased work load on the heart. Studies have shown that as the patient reduces his weight, the work load of the heart is concomitantly reduced. These studies, therefore, also suggest that elective surgery ideally should be postponed in obese patients until they have lost the excess weight. Unfortunately, from a practical point of view, these patients only rarely diet satisfactorily, and their weight reduction is usually minimal. Prospective studies have shown a