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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
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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

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