Can't have your surgery here.. you're too fat

Veil5577

A friend of mine is scheduled for an outpatient procedure, for a tonsillectomy.. She was scheduled at an outpatient surgical center. They cancelled her surgery without warning and she spoke to her doctor, who told her that the "new laws" regarding surgery now say that patients over a certain BMI have to have the surgery in a hospital, not the outpatient clinic.

I want to know what others think of this. First, this law is news to me, and I used to work in medical transcription. Second, I cannot see what complications could arise from a high BMI during surgery that the outpatient center couldn't handle as well as the hospital.

And third... my friend feels horrible now. She says she hopes she's not too fat for the hospital. And she isn't overly obese. She is overweight, but she doesn't weigh 500 lbs.

Thoughts?

Mr_Knight

...t the "new laws" regarding surgery now say that patients over a certain BMI have to have the surgery in a hospital, not the outpatient clinic.

There is some evidence that better long term outcomes result if obese patients have the procedures done as inpatients. I don't know that the evidence is conclusive, but it is at least suggestive. If we follow the "ounce of prevention...." philosophy, the new practices would seem to make sense.

And she isn't overly obese. She is overweight, but she doesn't weigh 500 lbs.

For an average height woman, I would say you're already beyond "overly obese" by the time you hit the low 200s. IIRC, the medical cut off is something like a BMI over 36 (again, going from memory).

Lauren8239

I've never heard of that being done anywhere except a hospital. I had mine out at 20. I'm in Canada so maybe that's the difference? Either way, I think with anesthetic it's safer to have it done in the hospital if overweight.........anesthetic is a tricky thing.

KrazyKristine7

That doesnt make sense to me. I could see if she was having something like her gall bladder removed but her tonsils? I think it's ridiculous especially for such a common procedure.

Veil5577

You make a good point. But she's having a simple procedure. I can understand if it were a complicated or dangerous procedure, but she is just having her tonsils out.

I haven't seen her in a while, but she's a little shorter than me (I am 5 ft 4 in) and I would guesstimate her around 250 lbs.

jimmmer

That doesnt make sense to me. I could see if she was having her gall bladder removed but her tonsils? I think it's ridiculous especially for such a common procedure.

There's no such thing as a risk-free surgery.

You would hope that they minimise the risks. I guess that's what the policy exists for. To cover the surgeon's *kitten* in case of a **** up.

FatFreeFrolicking

You make a good point. But she's having a simple procedure. I can understand if it were a complicated or dangerous procedure, but she is just having her tonsils out.

I haven't seen her in a while, but she's a little shorter than me (I am 5 ft 4 in) and I would guesstimate her around 250 lbs.

That's considered morbidly obese.

Anytime you are under anesthesia you are at a risk for complications. Better safe than sorry.

KrazyKristine7

That doesnt make sense to me. I could see if she was having her gall bladder removed but her tonsils? I think it's ridiculous especially for such a common procedure.

There's no such thing as a risk-free surgery.

You would hope that they minimise the risks. I guess that's what the policy exists for. To cover the surgeon's *kitten* in case of a **** up.

That's true, you are right. There is risk with any kind of surgery, it just seems so common.

whovian67

Obesity is defined. Liability-wise, that is a good decision for the facility. Health-wise, it is more conducive for your friend's well-being to be in a fully equipped facility just in case something goes awry. She shouldn't take offense.

Veil5577

Everyone has made some good points.. so answer me this....

Her weight was on record when the surgery was scheduled at the outpatient center.

So why didn't they schedule it in the hospital then instead of waiting until the day before the procedure to reschedule it because she is too heavy?

Hophead43

A friend of mine is scheduled for an outpatient procedure, for a tonsillectomy.. She was scheduled at an outpatient surgical center. They cancelled her surgery without warning and she spoke to her doctor, who told her that the "new laws" regarding surgery now say that patients over a certain BMI have to have the surgery in a hospital, not the outpatient clinic.

I want to know what others think of this. First, this law is news to me, and I used to work in medical transcription. Second, I cannot see what complications could arise from a high BMI during surgery that the outpatient center couldn't handle as well as the hospital.

And third... my friend feels horrible now. She says she hopes she's not too fat for the hospital. And she isn't overly obese. She is overweight, but she doesn't weigh 500 lbs.

Thoughts?

In today's litigious society I think you can chalk this one up to CYOA....or cover your own *kitten*. The outpatient facility probably doesn't have the same protection against malpractice as a hospital would. Therefore any person its deems ( rightfully so or not) a risk will be sent along to the more equipped facility.

Hophead43

Everyone has made some good points.. so answer me this....

Her weight was on record when the surgery was scheduled at the outpatient center.

So why didn't they schedule it in the hospital then instead of waiting until the day before the procedure to reschedule it because she is too heavy?

I would guess to say that is because of crappy staff not noticing it soon enough.

melinda200208

I am a surgery scheduler and our surgery center is in the beginning process of coordinating a policy that BMI has to be under a certain number. The higher BMI, the more risk for infection. This is for the safety of the patient. The reason they would need to go to a bigger hospital is because the hospital would have more resources and be more prepared for a high risk patient. I agree with it totally. If I was a surgeon, I wouldn't want to be doing surgery on a patient with a very high BMI. Actually with total joints right now, our surgeon will tell the patient they need to lose so much weight before surgery.

SoLongAndThanksForAllTheFish

Its obviously done for safety, I'm not sure why she would feel offended, I'd much rather feel humiliated than have them decide to increase my risk of death and other side effects and do it anyways without concern or telling me. Maybe instead she can take it as a wake up call to the additional risks she carries on a daily basis for not only surgery but diseases just going through her daily life obese? I know its difficult to react to information that seems to exclude you neutrally, but I'm always puzzled why people choose to take offense at medical doctors for trying to act in your best interest or alerting you to a safety issue. Its their job.

FatFreeFrolicking

Everyone has made some good points.. so answer me this....

Her weight was on record when the surgery was scheduled at the outpatient center.

So why didn't they schedule it in the hospital then instead of waiting until the day before the procedure to reschedule it because she is too heavy?

Doctors, nurses, receptionists, etc. who work in hospitals and outpatient facilities are super busy and frantic to begin with. They might not have noticed her weight at the time.

paniolo5

I don't know the science behind it, but my understanding is that obesity leads to a much higher risk of infection. My daughter works for a sport medicine facility and some of the doctors won't perform surgery on extremely obese folks due to the infection risk. Outpatient clinics are just that - they send you home very quickly after the procedure and they are not equipped to keep you overnight if complications occur. I had my tonsils out in a hospital & I'm very glad I did. I did not do well with the anesthetic & continud to throw up for several hours afterwards. Not good on the throat after having a tonsillectomy! They almost kept me overnight but they were finally able to get it under control for me. But I was there much longer than they expected when they set up the procedure. I agree with others, better safe than sorry!

Mr_Knight

You make a good point. But she's having a simple procedure. I can understand if it were a complicated or dangerous procedure, but she is just having her tonsils out.

Going under anesthetics is the tricky bit, from what my doc friends tell me, so it's not just about the complexity of the overall procedure.

Anyway, good luck to your friend! Either way, she'll get the care she needs, by the sounds of it, so it's all good from that perspective.

melinda200208

I am a surgery scheduler and our surgery center is in the beginning process of coordinating a policy that BMI has to be under a certain number. The higher BMI, the more risk for infection. This is for the safety of the patient. The reason they would need to go to a bigger hospital is because the hospital would have more resources and be more prepared for a high risk patient. I agree with it totally. If I was a surgeon, I wouldn't want to be doing surgery on a patient with a very high BMI. Actually with total joints right now, our surgeon will tell the patient they need to lose so much weight before surgery.

Also, there is always a risk with anesthesia. Higher BMI, higher risk

snowflake930

Everyone has made some good points.. so answer me this....

Her weight was on record when the surgery was scheduled at the outpatient center.

So why didn't they schedule it in the hospital then instead of waiting until the day before the procedure to reschedule it because she is too heavy?

^^This was what I was wondering. Why didn't they say something at the time they scheduled it?

dym123

Most likely a CYA situation. I had outpatient knee surgery a couple of years ago under a general, I was around 236lbs, so definitely a high BMI, but before they would do the surgery I had to have a bunch of blood tests to make sure I was healthy enough for the surgery. Maybe this is their way of skipping the blood test by just preventing fat people from have surgery.

BusyB223

I'm 207, my BMI is 33.4 which is Obese so at 250 she is a little more than that. It's best to have it done where she can be watched. Never know what her blood pressure might do and then to have to be rushed to the hospital could add more stress to the situation.

I would prefer the hospital no matter how simple the precedure may seem..

Veil5577

Thanks for the input guys. Personally I also think she's safer in the hospital, and I told her to let it go. She was pretty upset, crying, and I guess she's thinking they're body shaming her.

eggomylegos

During a tonsillectomy the patient is positioned on their back for an extended period of time. Overweight and obese individuals run a much higher risk of experiencing additional pressure on the lungs as a result. Also, the patient's throat is being operated on, further compromising their intake of oxygen. That combination could cause serious breathing complications. It would be safer to perform the procedure in a hospital where the staff is properly equipped to handle any major issues.

It is a bit ridiculous that no one caught this before she was scheduled, but I can understand the reasoning behind the change. It is for her safety, and yes it is definitely CYA for the surgeon.

melinda200208

Everyone has made some good points.. so answer me this....

Her weight was on record when the surgery was scheduled at the outpatient center.

So why didn't they schedule it in the hospital then instead of waiting until the day before the procedure to reschedule it because she is too heavy?

^^This was what I was wondering. Why didn't they say something at the time they scheduled it?

The surgeon should have noticed her BMI the day of consult. He shouldn't have even scheduled. The nurses probably prepped her chart the day before surgery and it was noticed. If her pre op was at the same facility, they should have caught it at that time as well.

Orfygirl

It is for fear of complications. My son had surgery when he was 8 months old to have extra digits removed. It was day surgery, the same surgery that my daughter had had a year earlier and was released within 1 hour post op. Due to and adverse reaction with the medication that my son was given helped along by his asthma, my son went into respiratory distress and ended up staying in the hospital for a week hooked up to tubes and on oxygen because he couldn't breathe on his own. Ever since then he has to have any and all surgeries in the hospital for fear of an adverse reaction. Even teeth pulled which can be done in a dentist's office.

The reason behind this law, not necessarily making it right, is that if people who have a higher BMI only have surgeries in hospitals it will prevent the doctor in the outpatient clinic from having to call an ambulance. In the lawmakers' eyes an overweight and/ or obese person has a higher chance of an adverse reaction to the medication given because of their weight, stress on their heart, yadda, yadda.

nutmegoreo

Another potential complication is the trauma caused to the airway by both the intubation and extubation processes. For someone who is obese, mix in airway trauma with the possibility of obstructive sleep apnea (you would be surprised how many people are unaware of being apneic, and this sometimes increases with weight) the procedure is much safer in an environment which can handle the potential complications.

As for why it was only noticed the day before, that is anyone's guess. The schedulers and nurses are busy and didn't notice. Perhaps it is a new policy being put into place. That is something to ask the clinic.

eamillie

Obesity is related to increased risk for DVTs and respiratory issues.

Personally, I'd prefer to be inpatient (with insurance) when getting surgery done. Any type.

americangirlok

I hope it doesn't jack up her insurance claim. Like they try to not pay it b/c she didn't have it as outpatient. I get that anesthesia is a tricky deal and that weight matters in that respect, but w/ so much of the country being overweight you'd think that there'd be people equipped to deal w/ that at any surgery center.

It would make me feel bad too- especially calling the day before and basically telling me I'm too fat for you to take care of it for me. And if that is the case I'd want to know before having it scheduled- or at least at the time it's scheduled. So yeah I feel for her, but maybe it is for the best for her to have it in the hospital? I just hope that it goes well for her and the insurance company doesn't screw her over over it.

MyOwnSunshine

I would guess that the concern is whether they can maintain an adequate airway in an outpatient setting. Obesity causes issues with airway obstruction, which would already be a concern with a surgery on one's throat. Outpatient centers usually have fewer anesthesiologists and respiratory therapists present, and if there was a need for emergent intubation and transfer to ICU for airway obstruction, it would be much more difficult in a outpatient setting.

This is not an issue of "fat shaming" or discrimination. This is a matter of medical safety. Not all procedures on all people are safe to perform in an outpatient setting.

onionparsleysage

Thanks for the input guys. Personally I also think she's safer in the hospital, and I told her to let it go. She was pretty upset, crying, and I guess she's thinking they're body shaming her.

I can definitely understand reacting like that. It's a shame that no one realized the issue until the day before, and it's very difficult to tactfully bring up weight in a conversation like that.

There was a recent high profile death of an obese girl in for a tonsillectomy, so I wouldn't be surprised if policies changed after that. I'd rather my doctor be extra cautious, however hard it is to hear.

AllOutof_Bubblegum

I cannot see what complications could arise from a high BMI during surgery that the outpatient center couldn't handle as well as the hospital.

Are you a doctor? Just because you can't see what could potentially go wrong don't mean there aren't a LOT of things that could go very wrong. Obesity causes increased risk of stroking out in the OR, either from transient blockages breaking free, or hypertension blowing arteries in the heart or brain. Those laws are there for a reason. And if your friend is going to be safer having it done in a hospital versus an outpatient clinic, why is she so upset? I for one would be happy to know I am in better hands and in the vicinity of better equipment. Not everything has to be taken personally. There are legal and medical reasons for it.

edited for typo