Perioperative Risks Are Similar for Normal versus Selected High-Body Mass Index Patients Undergoing Outpatient Hand and Elbow Surgery.
Adult
Ambulatory Surgical Procedures
/ adverse effects
Anesthetics, Intravenous
/ administration & dosage
Body Mass Index
Cohort Studies
Databases, Factual
Elbow Joint
/ physiopathology
Fentanyl
/ administration & dosage
Hand
/ physiopathology
Humans
Male
Midazolam
/ administration & dosage
Middle Aged
Patient Satisfaction
/ statistics & numerical data
Perioperative Care
/ methods
Reference Values
Retrospective Studies
Risk Assessment
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
entrez:
6
11
2019
pubmed:
7
11
2019
medline:
23
2
2020
Statut:
ppublish
Résumé
Many ambulatory surgery centers use body mass index as a screening tool to make admissions decisions because of complication risks associated with high-body mass index patients. The objective of this investigation was to evaluate perioperative complications in a cohort of high-body mass index patients undergoing hand and elbow surgery at an ambulatory surgery center. The authors' hypothesis was that anesthesia-related complications for this cohort would be similar to those of a normal-body mass index group. The authors retrospectively reviewed data from all hand and elbow procedures performed on patients with a high body mass index (>40 kg/m). One hundred eighty-nine high-body mass index patients and 189 normal-body mass index patients were included in the analysis. The average weight-based dosage of propofol was similar in both groups but was lower in the high-body mass index group for midazolam and fentanyl. Two high-body mass index patients had oxygen desaturations in the postanesthesia care unit. No patients developed complications related to anesthesia. In the high-body mass index group, one patient developed hypotension in the postanesthesia care unit, was admitted to the emergency room for monitoring, but was discharged the following morning. Outpatient hand surgical care of high-body mass index patients can be performed safely. Body mass index alone should not be considered as an absolute contraindication for surgery. Careful patient selection, evaluation of comorbidities, and close involvement of the anesthesia and medical teams are critical. Risk, II.
Sections du résumé
BACKGROUND
Many ambulatory surgery centers use body mass index as a screening tool to make admissions decisions because of complication risks associated with high-body mass index patients. The objective of this investigation was to evaluate perioperative complications in a cohort of high-body mass index patients undergoing hand and elbow surgery at an ambulatory surgery center. The authors' hypothesis was that anesthesia-related complications for this cohort would be similar to those of a normal-body mass index group.
METHODS
The authors retrospectively reviewed data from all hand and elbow procedures performed on patients with a high body mass index (>40 kg/m). One hundred eighty-nine high-body mass index patients and 189 normal-body mass index patients were included in the analysis.
RESULTS
The average weight-based dosage of propofol was similar in both groups but was lower in the high-body mass index group for midazolam and fentanyl. Two high-body mass index patients had oxygen desaturations in the postanesthesia care unit. No patients developed complications related to anesthesia. In the high-body mass index group, one patient developed hypotension in the postanesthesia care unit, was admitted to the emergency room for monitoring, but was discharged the following morning.
CONCLUSIONS
Outpatient hand surgical care of high-body mass index patients can be performed safely. Body mass index alone should not be considered as an absolute contraindication for surgery. Careful patient selection, evaluation of comorbidities, and close involvement of the anesthesia and medical teams are critical.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Risk, II.
Identifiants
pubmed: 31688759
doi: 10.1097/PRS.0000000000006152
pii: 00006534-201911000-00025
doi:
Substances chimiques
Anesthetics, Intravenous
0
Midazolam
R60L0SM5BC
Fentanyl
UF599785JZ
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
836e-840eRéférences
American Academy of Orthopedic Surgeons. Ambulatory surgical centers position statement. Available at: https://www.aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/position/1161%20Ambulatory%20Surgical%20Centers.pdf. Accessed September 11, 2019.
Keyes GR, Singer R, Iverson RE, et al. Analysis of outpatient surgery center safety using an internet-based quality improvement and peer review program. Plast Reconstr Surg. 2004;113:1760–1770.
Arance García M, Docobo Durántez F, Conde Guzmán C, Pérez Torres MC, Martín-Gil Parra R, Fernández Jiménez PE. Is obesity a risk factor for complications, hospital admissions, and surgical cancellations in ambulatory surgery? (in Spanish). Rev Esp Anestesiol Reanim. 2015;62:125–132.
Hofer RE, Kai T, Decker PA, Warner DO. Obesity as a risk factor for unanticipated admissions after ambulatory surgery. Mayo Clin Proc. 2008;83:908–916.
Joshi GP, Ahmad S, Riad W, Eckert S, Chung F. Selection of obese patients undergoing ambulatory surgery: A systematic review of the literature. Anesth Analg. 2013;117:1082–1091.
Whippey A, Kostandoff G, Paul J, Ma J, Thabane L, Ma HK. Predictors of unanticipated admission following ambulatory surgery: A retrospective case-control study. Can J Anaesth. 2013;60:675–683.
Cancienne JM, Brockmeier SF, Gulotta LV, Dines DM, Werner BC. Ambulatory total shoulder arthroplasty: A comprehensive analysis of current trends, complications, readmissions, and costs. J Bone Joint Surg Am. 2017;99:629–637.
Billing PS, Crouthamel MR, Oling S, Landerholm RW. Outpatient laparoscopic sleeve gastrectomy in a free-standing ambulatory surgery center: First 250 cases. Surg Obes Relat Dis. 2014;10:101–105.
Billing P, Billing J, Kaufman J, Stewart K, Harris E, Landerholm R. High acuity sleeve gastrectomy patients in a free-standing ambulatory surgical center. Surg Obes Relat Dis. 2017;13:1117–1121.
Munnich EL, Parente ST. Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up. Health Aff (Millwood) 2014;33:764–769.
Lopez PP, Stefan B, Schulman CI, Byers PM. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: More evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg. 2008;74:834–838.
Martín-Ferrero MÁ, Faour-Martín O, Simon-Perez C, Pérez-Herrero M, de Pedro- Moro JA. Ambulatory surgery in orthopedics: Experience of over 10,000 patients. J Orthop Sci. 2014;19:332–338.
Goyal KS, Jain S, Buterbaugh GA, Imbriglia JE. The safety of hand and upper-extremity surgical procedures at a freestanding ambulatory surgery center: A review of 28,737 cases. J Bone Joint Surg Am. 2016;98:700–704.