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

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

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.