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

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

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.

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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You I like

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.

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

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.

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.

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.