A report from the Centers for Disease Control found that more than 48 million surgical and nonsurgical procedures are performed in hospitals and ambulatory surgery centers annually. Another study estimates that Americans undergo an average of nine surgical procedures in a lifetime, including in-patient, out-patient and non-operating room invasive procedures. With surgery comes risk, and for people with obesity that risk can be significant.
Surgery on patients with obesity is more complicated due to their increased adiposity and often results in longer procedures, extended time under anesthesia, more blood loss and lengthier hospital stays. These patients also are more likely to be admitted to an intensive care unit and require a ventilator than non-obese patients. This can lead to higher surgical site infections, increased readmissions, decreased rate of dismissal to home and increased costs for all involved. Although the level of risk varies, it is consistent across various types of surgery including orthopedic, cardiovascular, gastroenterological, plastic surgery and labor and delivery as representative examples.
With literally millions of surgeries occurring each month, the medical challenges faced by patients can quickly become financial burdens for physicians and the health care system. The increased likelihood of surgical and post-surgical complications means that procedures with added difficulty, risk and time requirements will exceed the standard parameters set by Centers for Medicare & Medicaid Services (CMS) and other insurance providers. As such, the predetermined, flat reimbursement rate does not fully cover the costs that are inherent in these more complex surgeries. Similarly, “higher than expected” readmission rates are likewise penalized by the CMS, essentially discriminating against treating patients with obesity or others who are physically or socioeconomically disadvantaged.
One recommendation has been to treat patients with obesity in health care facilities that specialize in the specific illness or disease for which they are being treated. This ensures that medical staff and equipment with most critical to the need being treated are in place. While this might contribute to healthier medical outcomes, these facilities would be treating higher risk conditions, thus incurring greater costs, thereby facing the same issues with CMS and other insurers.
One way to minimize post-surgical risks is pre-surgery weight loss, and physicians should encourage participation in a monitored weight loss program as a criterion for surgery. In-house weight management programs have the added benefit of keeping the patient and their medical history accessible. These programs offer support and counselling to help patients lose weight and attain positive surgical outcomes. A Very Low Calorie Diet (VLCD) or Low Calorie Diet (LCD), such as New Direction Advanced, improves surgical eligibility, minimize medical complications during surgery and reduce post-surgery hospital costs and readmissions. Many hospitals already have established programs which have helped prevent 43,000 cases of obesity over 10 years.
Preventing surgical complications before they arise offers the greatest benefits to the patient, and weight loss is the first step. When this is not possible, the medical community must remain updated on the best practices and resources needed to ensure the health and safety of all patients and minimize risk before, during and after surgery.