Orthopedic Surgeons Refuse to Operate on the Obese

Many orthopedic surgeons are refusing to operate on overweight and obese patients, claiming they are at higher risk of medical complications, take longer to recover, and often need repeat procedures.

Surgical wounds in obese patients usually require multiple layers of stitches, heal more slowly because of diminished blood supply to fatty tissue, and are more likely to develop pressure sores in bed. Because of the larger amounts of fatty tissue, injections are less effective since regular needles are too short, and locating blood vessels for intravenous tubing is more difficult. As a result of the additional physical demands made on the surgeon and the poorer outcomes, many surgeons are refusing to operate unless the patient first loses a significant amount of weight. These concerns have led several National Health Service (NHS) clinics in Britain to refuse hip and knee replacements to patients whose body mass index (BMI) is 30 or more, the obesity threshold established by the World Health Organization (WHO, Geneva, Switzerland).

In a retrospective cohort study of 1,343 patients who underwent hip replacements at two San Diego (California, USA) hospitals, patients with a BMI of 35 or more were almost three times as likely to need additional stay at a rehabilitation facility before going home, and twice as likely to suffer a health-related complication while they were there, according to first author Thomas Robert Turgeon, M.D. (Winnipeg, Canada). The findings are being presented at the 2006 annual meeting of the American Academy of Orthopedic Surgeons (AAOS) in Chicago (Illinois, USA) in March 2006.

The number of hip and knee replacements in the U.S. doubled between 1993 and 2003, according to the AAOS. While an aging population contributed to these figures, obesity was a large factor.



Related Links:
American Academy of Orthopedic Surgeons