Surgical procedures have several risks, particularly if general anesthesia is used. Morbid obesity increases these risks substantially. When evaluating a morbidly obese patient, surgeons must consider these risks and take steps to minimize the chances of serious surgical complications. This can involve delaying surgery, using specific anesthetics or using additional monitoring tools during surgical procedures.
Pulmonary Embolism
Pulmonary embolism is a sudden blockage of one of the arteries in the lungs. This is caused by a clot that forms in another part of the body and travels through the bloodstream to the lungs. Morbidly obese patients are at an increased risk of developing blood clots in the lungs after surgery, especially if measures are not taken to prevent clots from forming. Monitoring oxygen levels in morbidly obese patients after surgery is indicated. Sudden decreases in oxygen levels can help diagnose a pulmonary embolism quickly so life-threatening complications can be prevented.
Wound Infections
Morbid obesity increases the risk of post-operative wound infections, increasing the risk that someone will develop a blood infection or die from overwhelming infection. Researchers from Texas Tech Health Sciences Center studied post-operative infections in women who had undergone Cesarean sections. Even when antibiotics were administered to prevent infection, obese women experienced infections at a rate significantly higher than women of normal body mass. The results of the Texas Tech study were published in the November 2000 issue of "Obstetrics and Gynecology."
Airway Maintenance
Morbid obesity makes it difficult for medical professionals to maintain an open airway during surgery. Obesity adds extra weight to the chest and makes it difficult for the diaphragm to function properly when a person is lying down. "RT Magazine," a journal for respiratory therapists, indicates that morbidly obese patients may also experience limited airflow, lower lung volumes and increased pulmonary blood volume. Intubating a morbidly obese person before surgery is difficult because of limitations in neck movement and difficulty opening the mouth. Extra monitoring may be necessary to prevent serious surgical complications as a result of the difficulty in maintaining an unobstructed airway.
Deep Vein Thrombosis
Deep vein thrombosis is a blood clot that occurs in one of the deep veins of the body. These veins are found in the calves, thighs and pelvis. During lengthy surgical procedures, the risk of developing a blood clot in one of these veins increases. Limited physical activity after a surgical procedure also increases the risk for deep vein thrombosis. Compression stockings can help prevent these clots in morbidly obese patients. Allowing a patient to walk as soon as possible after surgery can also help to prevent this surgical complication.
Suture Complications
Sutures (stitches) are often used to close surgical incisions so that the tissues can heal normally. Morbid obesity makes it difficult for surgeons to adequately and safely close incisions made during a surgical procedure. Special suturing techniques may be required to close the incisions of morbidly obese patients. Wound infection is also more likely in someone who is morbidly obese, especially when excess skin folds make it difficult to properly clean and bandage surgical wounds. Obese patients with old surgical scars may also experience incisional hernia, which is a weakening of the abdominal wall where past surgery was performed.
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