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

newdaydawning79

I personally would want most surgeries to take place in a hospital in case of complications myself (even if I wasn't overweight). I've seen too many horror stories with my own eyes. The whole waiting til the day before and just throwing it at her like that sucks though. Whoever recommended the surgery to start with should have known better (unless the procedure suddenly changed between then and now, which is unlikely the way things are usually done).

Tell her she's safer for it and to not let it get to her.

That being said, I'm glad this wasn't in effect when I had my breast reduction surgery! THAT is something I wouldn't want done in a hospital. Much rather have it in the plastic surgeon's office which is connected to the hospital via a skywalk. LOL

kingscrown

My thoughts get over yourself. They are erring on the side of safety for you and for them. So what if you might not fit into that blanket coverage. Maybe you do and you'll be glad you're in the hospital with all the equipment necessary to keep you alive.

Veil5577

I don't think she would have been this upset if they had scheduled it right in the first place. It was her doctor who made the mistake and scheduled the procedure in the outpatient clinic, and the clinic cancelled it because of her BMI.

As I said, I told her to let it go and to calm down, all she needs to worry about is getting through the procedure and recovering from it.

liekewheeless

I hope she feels better about the situation soon. I agree the hospital will be safer, but I understand that when things are different than you prepared for, your emotions can get the best of you.

Not the same but when I had my daughter I was hoping to be out of the hospital quickly. The second day I was all set to go, I never got the inclination that I would have to stay another day (or I should say, my daughter had to stay another day). There were just a couple of numbers not quit where they wanted them for my daughter, and I was told we couldn't go home yet.

Of course it was better to stay the extra day and be sure all was well before leaving. But right then it was really hard emotionally to not get to take her home that day.

365andstillalive

To be fair, you did classify it as a "new law", the office very likely could have been playing catch-up trying to find all the patients that violated it. I'm guessing it's less a law than a policy change, but as someone who worked in a 7 GP office for a few years, it's hard to keep up with things like that. You're dealing with so much that sometimes small details, like someones weight, get glossed over unless it seems medically relevant, which if the policy wasn't in place at the booking of her appointment, it wasn't.

It's a good thing to do it in the hospital and just try to keep stressing to her the safety aspect of doing it there. Anesthetics really screw with people, but the higher the weight of the person the more variables you can be dealing with as there can be a huge host of underlying issues related to being over-weight, or even just genetic history, that you discover because you're under anesthetic. Or god forbid she happens to be allergic to it. It's safer for her, and for anyone really, to have a surgery done where she's going to get the best care possible.

stephe1987

BMI (kg/m2) Classification
< 18.50 underweight
18.50–24.99 normal weight
25.00–29.99 overweight
30.00–34.99 class I obesity
35.00–39.99 class II obesity
≥ 40.00 class III obesity

5' 3" and 250 lbs is a BMI of 44.3. :frown:

I'm guessing the law is new so they didn't catch it right away; otherwise, they would/should have scheduled her properly the first time. It's better to be safe because every surgery has risk and you don't want to be away from a hospital should something go wrong. They really should do that for everyone.

Maybe after she's recovered from surgery you could offer to go on walks together or go to the gym. Help her get started on her weight loss journey, maybe if she talks about wanting to lose weight you could suggest that she sign up here at MFP to meet other people who have similar amounts of weight to lose, or have had big losses and shared their success stories. But it has to be in a kind way, not pressuring her. She has to want to do it and be ready because it's not an easy road.

Hammybone

I would be fairly annoyed that my procedure was moved, assuming that I would have rearranged my schedule around it. However, I think my family would be seething with anger if I died simply because my facility knew that another was better equipped to care for me as a "high risk" patient and failed to do anything about it.

Though it makes me wonder, who/what actually does slip through the cracks?

Veil5577

BMI (kg/m2) Classification
< 18.50 underweight
18.50–24.99 normal weight
25.00–29.99 overweight
30.00–34.99 class I obesity
35.00–39.99 class II obesity
≥ 40.00 class III obesity

5' 3" and 250 lbs is a BMI of 44.3. :frown:

I'm guessing the law is new so they didn't catch it right away; otherwise, they would/should have scheduled her properly the first time. It's better to be safe because every surgery has risk and you don't want to be away from a hospital should something go wrong. They really should do that for everyone.

Maybe after she's recovered from surgery you could offer to go on walks together or go to the gym. Help her get started on her weight loss journey, maybe suggest that she sign up here at MFP to meet other people who have similar amounts of weight to lose, or have had big losses and shared their success stories.

That is an excellent suggestion! When she recovers from her surgery I will see if I can interest her. She has a big family, hopefully she can find the time.

bugaha1

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?

I think the patient should be able to make the final decision and the hospital should only be able to recommend surgery in the hospital. This is just another way for hospitals and doctors to run up the bill.

pamelas9

Shortly after I had gained most of my weight I had my wisdom teeth removed... only to wake up to a visibly shaken oral surgeon. They had a hard time getting me to sleep and an even harder time waking me up. They were less than 5 minutes from calling an ambulance and getting me to the hospital. And they do surgery every day of the week.

Hospitals have anesthesiologists and more choice as to the right drugs to use and better monitoring and more staff to support the whole process. I think it is a common sense measure with good data behind. It does really suck that they waited until the last minute to get the scheduling right for your friend, but maybe this is a wake up call that she needs?

All of us who are morbidly obese go through it. Special accommodations that we or others have to make because of the shape we are in. That is what prompts a lot of us to make a change, because we are tired of weight being a limiting factor to our health and happiness.

melinda200208

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?

I think the patient should be able to make the final decision and the hospital should only be able to recommend surgery in the hospital. This is just another way for hospitals and doctors to run up the bill.

I disagree. Surgeons should be the one to make the choice. Afterall, they are the experts. The surgeon's duty is to do what is best for the patient. And, I am assuming (if i read correctly) they are sending the patient to a hospital. A different facility. So, they aren't doing this to "make more money" They are doing it for the safety of the patient. If I was a surgeon, I wouldn't do it. Liability, lawsuits....safety of patient

acpgee

I've had ankle surgery cancelled two days before the procedure due to potential airway problems. I had had a laryngoscopy two years prior to fix some scarring in my airway. Anyway, the anaesthetist refused to touch me until I provided a declaration from the ear nose and throat surgeon to clear me for general anesthesia.

Apparently the anaesthetist generally doesn't review his cases until two days before the scheduled surgery.

melinda200208

I've had ankle surgery cancelled two days before the procedure due to potential airway problems. I had had a laryngoscopy two years prior to fix some scarring in my airway. Anyway, the anaesthetist refused to touch me until I provided a declaration from the ear nose and throat surgeon to clear me for general anesthesia.

Apparently the anaesthetist generally doesn't review his cases until two days before the scheduled surgery.

Suprisingly, they don't. Sometimes, they don't even review them until the day of surgery. Very unfortunate.

charlieandcarol

I think the patient should be able to make the final decision and the hospital should only be able to recommend surgery in the hospital. This is just another way for hospitals and doctors to run up the bill.
[/quote]

This is a pathetic statement. I have worked in ICU for 20 years and have looked after many people who had cardiac arrests or severe anaphylactic reactions during the induction phase of their anesthesia for procedures considered by themselves or their family as "minor". Some of these patients died and they didn't even actually have the surgery. Any procedure that requires a general anesthetic is not minor.

I have also looked after many overweight, obese and severely obese patients who had minor procedures who had strokes, pulmonary emboli or were simply slow to wake up after their procedure or unable to be extubated due to having fat necks. The only known risk factors these patients had were their weight. Of course these things can happen to people who aren't overweight but they are a higher risk if you are overweight. Day surgery units do not have ICUs or ICU specialist staff. Delays in accessing this kind of care, especially for ops that involve surgery on an airway can risk hypoxia resulting in brain injuries and/or death.

Patient safety is paramount. I am sorry your friend is feeling bad. Obviously it could have been handled better.

VBnotbitter

I think the patient should be able to make the final decision and the hospital should only be able to recommend surgery in the hospital. This is just another way for hospitals and doctors to run up the bill.

This is a pathetic statement. I have worked in ICU for 20 years and have looked after many people who had cardiac arrests or severe anaphylactic reactions during the induction phase of their anesthesia for procedures considered by themselves or their family as "minor". Some of these patients died and they didn't even actually have the surgery. Any procedure that requires a general anesthetic is not minor.

I have also looked after many overweight, obese and severely obese patients who had minor procedures who had strokes, pulmonary emboli or were simply slow to wake up after their procedure or unable to be extubated due to having fat necks. The only known risk factors these patients had were their weight. Of course these things can happen to people who aren't overweight but they are a higher risk if you are overweight. Day surgery units do not have ICUs or ICU specialist staff. Delays in accessing this kind of care, especially for ops that involve surgery on an airway can risk hypoxia resulting in brain injuries and/or death.

Patient safety is paramount. I am sorry your friend is feeling bad. Obviously it could have been handled better.
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missycj87

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?

I think the patient should be able to make the final decision and the hospital should only be able to recommend surgery in the hospital. This is just another way for hospitals and doctors to run up the bill.

thats ridiculous. since when did the patient become the expert? just look at what happened to kanye west mother. she was looking to get elective surgery(for whatever reason), and she couldnt find a doctor to perform the operation because she was a high risk patient. she found an incompetent doctor who was willing to help her out despite the serious risks to her health and she died on the operating table. so now he loses his license to which he deserved, but good luck finding many other doctors willing to risk their license that they earned by going to school for a million years, all to avoid hurting a patients feelings because they dont want to face reality about their OWN health.

FitOldMomma

Not only surgery...I had to be prescreened just to see if I could have a colonoscopy at the gastroenterology center, rather than a hospital setting.

I was so embarrassed by it all. But, after meeting with the doctor I understood the risk with my high BMI. It has to do with anesthesia.
They wanted to see me in person, they especially wanted to check the fat around my neck. Apparently that can be problematic for the airway.
Anyway, I'm lucky enough that I don't have much fat around my neck so I was able to have the procedure in the outpatient center.

The screener told me anyone with a BMI of higher than 40 had to be pre-approved.

Also, I was turned down by a knee surgeon due to my weight and BMI. His stance is that there are not good outcomes for knee replacement surgery on very obese people. THAT was the impetuous for me to finally get serious about my health and fitness and I joined in here at MFP.

WombatHat42

It is for liability reasons. Anesthesia can be more harmful for larger patients(sometimes it is dosed based on weight so that increases the risk of negative side effects) If something happened while they were under the outpatient center is not properly equipped to deal with it as well as a hospital

kaseysospacey

My local hospital wont let patients deoiver babies over a 40bmi...you have to drive two hrs away to dartmouth hitchcock its crap

Miss_1999

Ironically enough, it's not as easy of a surgery as you'd think, at least not for adults. It is a pretty routine surgery, but it's typically performed on children and teens, not adults. From one article I read, the older you are, the harder it can be for the surgeon to get your tonsils out- because every time you have a sore throat, it builds up scar tissue around the tonsils. Then, on top of that around 20% of adults end up with complications from the surgery, some that are major enough to land them BACK in the hospital. For me, that would be enough for me to WANT to have the surgery in the hospital to begin with, obese or not.

When I had surgery in 2010 at Vanderbilt, I was on my stomach the entire time (I had an obstetric fistula repair). I weighed roughly 240lbs pounds. My surgeon told me, "After the amount of weight you've lost, I feel absolute horrible about labeling you *obese*, after how far you've come, but from a medical stand point, I have to keep you safe." So, every four hours, a nurse came into my room, and shot me up with Heparin to make sure I didn't get a blood clot, and I had to wear these things around my calves that inflated and deflated every so often during the night. Those, I didn't mind, they felt kind of like massagers, but the shots- when I'm trying to sleep and I feel something in my thigh, yeah, I didn't enjoy that. My surgeon really didn't feel as if I'd get a blood clot, and told me my risk was minimal, BUT he had to cover his behind, and I understand that.

MKEgal

Those laws are there for a reason

I doubt it's a law.
People like to blame things on the gov't, but this is probably a health-related policy put in place by the facility.

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).

Someone who is 5'9" or less is obese at 200 lb, and the cutoff for obesity is a BMI of 30.
http://www.shapeup.org/bmi/bmi6.pdf

she's a little shorter than me (I am 5 ft 4 in) and I would guesstimate her around 250 lbs

At 5'4" and 250, that's a BMI of 43, which is FAR into the obese range.
I don't know where the cutoff is for "morbidly obese", but wouldn't be surprised if that's past it.

Then someone posted this:
< 18.50 underweight
18.50–24.99 normal weight
25.00–29.99 overweight
30.00–34.99 class I obesity
35.00–39.99 class II obesity
≥ 40.00 class III obesity

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?

Good question, and one she should ask her doctor. The scheduling people screwed up, and maybe they didn't pass along her weight info to the surgical center. (But how did that place know how fat she is in order to cancel the procedure? Did they do a phone interview the day before?)

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

Yep.

I'm 207, my BMI is 33.4 which is Obese so at 250 she is a little more than that

Depends on height.
She is apparently quite short.

I guess she's thinking they're body shaming her

If they were rude or mean about it, that phrase would have meaning.
I think it's vastly overused.
If they simply said "our policy is not to accept patients over a certain BMI because of the risk of complications, so you need to go to a hospital" that's NOT "body shaming". That's good medicine.

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

If she's going to be under anaesthesia, unconscious, and especially having her throat operated on, they're going to intubate her right up front, as soon as she's under, no matter where she is.

There were just a couple of numbers not quit where they wanted them for my daughter, and I was told we couldn't go home yet.

You can _always_ refuse treatment, for yourself or your minor child. That includes leaving the hospital if you want.

HelenO20

Tonsilectomies should prob be done as an impatient anyways because of the risk of post op bleeding and blocking of the airways.

MyOwnSunshine

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

If she's going to be under anaesthesia, unconscious, and especially having her throat operated on, they're going to intubate her right up front, as soon as she's under, no matter where she is.
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It's not unheard of for ENT patients, or morbidly obese patents to require reintubation after they are extubated in the PACU. Both situations increase the risk of respiratory arrest.. Reintubation would likely require a skill set not present in an outpatient setting. If it were me or my loved one, I would prefer in-patient setting with access to multiple anesthesiologists, intensivists and ICU staff.

brower47

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?

The hospital has far more emergency workers and better equipped facilities (ICU) to deal with unexpected complications. The fact that a high BMI carries with it higher chances of surgical complications makes me think this law is designed to save patients lives. I'm sorry your friend had her feelings hurt but that can't be a factor is determining risk factor and safety. I would rather have my feelings hurt than die on the operating table.

Oi_Sunshine

Does your friend want a successful and safe surgery or does she want her feelings coddled?
It's nothing personal and hopefully she will put her own health first instead of her feelings on the matter.

h7463

She was pretty upset, crying, and I guess she's thinking they're body shaming her.

Every day I learn something new on this site. Some things I wish I never heard about. Instead of being relieved she's going under at a hospital rather than some ambulatory clinic, she's crying about being body shamed. WTF? Oh yeah. First World problems.

I'm right there with you on the educational value of this site....lol

There are some pricey problems on the issue of obese people requiring health care here, that are so obvious, they have not even been addressed yet.
My niece is an ultrasound technician in a large hospital here. On a daily basis, she has to yell and scream for help and extra 'muscle' to move around and hold up the large amounts of excess fat, in order to properly perform the scans.
I think, it's safe to assume that in a small clinic, there are only a small number of people available to help out in case a severely overweight person needs to be moved. Not to mention the special equipment, not limited to, but including the extra strong beds and operating tables necessary to hold up to the load. How about the ambulance service? Some vehicles are not equipped to transport the heavy patients, and a special ambulance is not always available.
Seriously, though, who is going to pay for all of those things that the large number of the 'average size' population will never need in the first place? And I don't think the doctors or hospitals are going to make all this extra money on sending the patients from outpatient to inpatient treatment.

Just my opinion.