Obesity and Surgery

Obesity and surgery 1. Increased Surgical Risks: o Blood Clots: Obesity raises the risk of blood clot formation (deep vein thrombosis) during surgery. o Infections: Obese individuals are more susceptible to wound infections and surgical site infections. o Respiratory Problems: Excess weight can strain the respiratory system, leading to breathing difficulties after surgery. o Delayed Recovery: Longer hospital stays and slower postoperative recovery. o Anesthesia Challenges: Locating veins for anesthesia, determining medication doses, and ensuring proper oxygen supply can be more complex. o Sleep Apnea: Obesity increases the likelihood of sleep apnea, which affects anesthesia safety. 2. Organ Strain: o Obesity places additional strain on organs (heart, lungs, liver, kidneys), affecting their function during surgery. 3. Pressure Injuries: o Obese patients are at higher risk of pressure injuries (bedsores) due to prolonged immobility during recovery. 4. Length of Stay: o Obese patients may require longer hospital stays for monitoring and management. Methods of obesity assessment 1. Body Mass Index (BMI): o BMI is calculated by dividing a person’s weight in kilograms by the square of their height in meters. o It provides an estimate of body fat based on weight and height. o BMI correlates with more direct measures of body fat, such as skinfold thickness, bioelectrical impedance, and dual-energy X-ray absorptiometry (DXA). o It is an inexpensive and easy-to-perform screening method11. 2. Waist Circumference: o Measures the circumference of the waist at the level of the navel. o Abdominal obesity (central adiposity) is associated with increased health risks. o A waist circumference above certain thresholds indicates higher risk22. 3. Skinfold Thickness Measurements: o Measures the thickness of skinfolds at specific sites (e.g., triceps, subscapular, suprailiac). - - - - o Chest or pectoral skinfold: For men, get a diagonal fold half way between the armpit and the nipple. In women, a diagonal fold 1/3 of the way from the arm pit to the nipple. Mid-Axillary: A vertical fold on the mid-axillary line which runs directly down from the centre of the armpit. Supra-iliac or flank: A diagonal fold just above the front forward protrusion of the hip bone (just above the iliac crest at the midaxillary line). Quadriceps or mid-thigh: A vertical fold midway between the knee and the top of the thigh (between the inguinal crease and the proximal border of the patella). Abdominal: A horizontal fold about 3 cm to the side of the midpoint of the umbilicus and 1 cm below it. Triceps: A vertical fold midway between the acromion process and the olecranon process (elbow). Biceps: A vertical pinch mid-biceps at the same level the triceps skinfold was taken. Subscapular: A diagonal fold just below the inferior angle of the scapula. Medial calf: The foot is placed flat on an elevated surface with the knee flexed at a 90° angle. A vertical fold taken at the widest point of the calf at the medial (inner) aspect of the calf. Used to estimate subcutaneous fat. o Requires trained personnel and specialized callipers. 4. Bioelectrical Impedance Analysis (BIA): o Measures electrical resistance as a proxy for body composition. o Estimates body fat percentage based on electrical conductivity. 5. Dual-Energy X-ray Absorptiometry (DXA): o Provides detailed information on body composition (fat, lean tissue, bone density). o Used in research and clinical settings.