We are ringing in the New Year and many of us are thinking about losing weight. That is wonderful. Besides looking and feeling better after weight loss, you are also in better shape for surgery. It is very important is to understand that obesity matters in surgical safety. Let me share my experience as a plastic surgeon who operates primarily in an ambulatory surgery center.
Most patients receive intravenous sedation and pain medications during surgery. Most of these medications are fat-soluble. This means more of the drugs will be going into the fatty tissue and therefore more is needed to achieve the desired anesthesia or sedation than in a person without obesity. The additional medication given to the obese patient will accumulate and stay lodged in the fatty tissue until after the procedure.
When the surgery is over, the reverse process happens. More medication will move from the fat into the blood and will still linger in the circulation even when the drugs are no longer being injected. That means it will likely take much longer for the patient to wake up from anesthesia and recover. What is even more concerning is that the anesthesia and pain medication will continue to come out from the fatty tissue into the circulation after the patient goes home. Often, the patient will take more pain pills at home and this will further increase the narcotic level. This can lead to respiratory depression in a typical home setting that lacks continuous monitoring. This is why obesity matters in surgical safety. In fact, we do not perform surgery in a person with a BMI more than 35 at the Sandia Surgery Center.
In addition, obesity could contribute to other surgical risks. Deep vein thrombosis (DVT or blood clots in the legs), pulmonary embolism (PE or blood clots in the lungs), infection, and difficult wound healing issues can be higher in obese patients. If you plan to lose weight as one of your New Year’s resolutions, stick with your goal, especially if you are planning to have surgery. I can not over-emphasize that obesity matters in surgical safety.