Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-26T16:13:05.253Z Has data issue: false hasContentIssue false
  • English
  • Français

How to inform a morbidly obese patient on the specific risk to develop postoperative pulmonary complications using evidence-based methodology

Published online by Cambridge University Press:  20 January 2006

S. Flier  and
J. T. A. Knape
S. Flier
Affiliation:
University Medical Centre Utrecht, Department of Perioperative Care and Emergency Medicine, Utrecht, The Netherlands
J. T. A. Knape
Affiliation:
University Medical Centre Utrecht, Department of Perioperative Care and Emergency Medicine, Utrecht, The Netherlands
Get access

Extract

Summary

Background and objective: Patients have the right to be informed about the expected benefits and risks of medical and surgical procedures. Ideally this information should be scientifically based and presented to the patient in time. In morbidly obese patient undergoing general anaesthesia, postoperative pulmonary complications are an important cause of postoperative morbidity and mortality. A 46-yr-old female with a body mass index of 89.8 kg m−2 was scheduled to undergo radical abdominal surgery for cervix carcinoma. In order to inform her accurately on the risk of developing postoperative pulmonary complications, we undertook to answer the following question: What is the risk to develop postoperative pulmonary complications in a morbidly obese patient about to undergo abdominal surgery under general anaesthesia? Methods: A Medline search was conducted from 1966 to 2004 with respect to postoperative pulmonary complications in abdominal surgery of morbidly obese patients. Altogether, 213 articles were found, of which seven were selected. Additionally, seven cross-references and or related articles were used. Results: For obese patients who undergo abdominal surgery under general anaesthesia, the likelihood to develop atelectasis is 10.4 ± 4.8% (P < 0.001) with a correlation coefficient of 0.28–0.34 (P < 0.05). The likelihood to develop atelectasis and pneumonia taken together is 29.3% with an adjusted odds ratio of 2.82 (95% confidence interval 1.66–4.78; P = 0.0001). Conclusion: Considering the positive correlation coefficient and the high body mass index of this patient she has a risk of at least 29.3% to develop pneumonia and/or atelectasis, which should affect the anaesthetic strategy in this patient.

Keywords

ANAESTHESIA GENERALOBESITY MORBIDSURGERYPOSTOPERATIVE COMPLICATIONS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 2 , February 2006 , pp. 154 - 159
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

World Health Organization. Global strategy on diet, physical activity and health. Resolution WHA 57.17, 2004; May 22; available from URL http://www.who.int/dietphysicalactivity/strategy/eb11344/en/ on July 20, 2005.
Aitkenhead AR, Rowbotham DJ, Smith G. Textbook of Anaesthesia. London, Great Britain: Churchill Livingstone, 2001: 445, 532.
Øberg B, Poulsen TD. Obesity: an anaesthetic challenge. Acta Anaesthesiol Scand 1996; 40: 191–200.Google Scholar
Pasulka PS, Bistrian BR, Benotti PN, Blackburn GL. The risks of surgery in obese patients. Ann Intern Med 1986; 104: 540–546.Google Scholar
Forrest JB, Rehder K, Cahalan MK, Goldsmith CH. Multicenter study of general anaesthesia. III. Predictors of severe perioperative adverse outcomes. Anesthesiology 1992; 76: 3–15.Google Scholar
Mason EE, Renquist KE, Jiang D. Perioperative risks and safety of surgery for severe obesity. Am J Clin Nutr 1992; 55 (Suppl 2): 573S–576S.Google Scholar
Rose DK, Cohen MM, Wigglesworth DF, DeBoer DP. Critical respiratory events in the postanesthesia care unit. Patient, surgical, and anesthetic factors. Anesthesiology 1994; 81: 410–418.Google Scholar
Garibaldi RA, Britt MR, Coleman ML, Reading JC, Pace NL. Risk factors for postoperative pneumonia. Am J Med 1981; 70: 677–680.Google Scholar
Coussa M, Proietti S, Schnyder P et al. Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg 2004; 98: 1491–1495.Google Scholar
Blouw EL, Rudolph AD, Narr BJ, Sarr MG. The frequency of respiratory failure in patients with morbid obesity undergoing gastric bypass. AANA J 2003; 71: 45–50.Google Scholar
Ogunnaike BO, Jones SB, Jones DB, Provost D, Whitten CW. Anesthetic considerations for bariatric surgery. Anesth Analg 2002; 95: 1793–1805.Google Scholar
Flancbaum L, Choban PS. Surgical implications of obesity. Annu Rev Med 1998; 49: 215–34.Google Scholar
Dominguez-Cherit G, Gonzalez R, Borunda D, Pedroza J, Gonzalez-Barranco J, Herrera MF. Anesthesia for morbidly obese patients. World J Surg 1998; 22: 969–973.Google Scholar
Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest 1997; 111: 564–571.Google Scholar
Delgado-Rodriguez M, Medina-Cuadros M, Martinez-Gallego G, Sillero-Arenas M. Usefulness of intrinsic surgical wound infection risk indices as predictors of postoperative pneumonia risk. J Hosp Infect 1997; 35: 269–276.Google Scholar
Strandberg A, Tokics L, Brismar B, Lundquist H, Hedenstierna G. Constitutional factors promoting development of atelectasis during anaesthesia. Acta Anaesthesiol Scand 1987; 31: 21–24.Google Scholar
Het Dutch Cochrane Centre; The Cochrane Collaboration; available from URL http://www.cochrane.nl/index.html on July 20, 2005.
Philips B, Ball C, Sackett D et al. Levels of evidence and grades of recommendation. Oxford Centre for Evidence Based Medicine, 2001; available from URL http://www.cebm.net/levels_of_evidence.asp on July 20, 2005.
Seymour DG, Pringle R. Post-operative complications in the elderly surgical patient. Gerontology 1983; 29: 262–270.Google Scholar