Obesity

synonyms:

ICD-9

Obesity

• Definition = body mass index (BMI) > 30.
• Treatment of obese orthopaedic patients requires increased operative time and effort with increased risk of surgical complications and poor outcomes
• Add modifier -22 to claims and document difficulties related to obesity in the operative note.
• Linked to HTN, diabetes and CAD.
• Anesthesia considerations: difficult airway control due to short thick necks, lower lung capacity, increased risk of pulmonary aspiration.
• Surgical considerations: increassed pressure related problems (alopecia, Rhabdomyolysis, compartment syndrome, nerve palsy, permanenet thoracic level paraplegia, increased surgical times, increased risk of infection, skin slough, poor wound healing Poor radiographic images, operating table weight restrictions, surgical instrument sizing,
• References: Bhattacharyya GD, JAAOS 2007:14:425.
• Increased risk of complications: DVT/PE, infection, blood loss.
• From 1960 to 2000, the rate of obesity more than doubled in the United States—from 12.8 percent to 30 percent. (AAOS Now)
• More than 60 percent of all Americans are now considered to be overweight or obese based on a BMI of 30 or more. (AAOS Now)
• Morbidly obese patients substantially increases a persons chance of needing a joint replacement. Obese patients having a joint replacement have higher complications rates includeing increased pain, increased infection rate, increased risk of loosening, increased revision rate.

Etiology / Epidemiology / Natural History

Anatomy

Clinical Evaluation

• Body Mass Index (BMI) = wt (kg) / height² (m²). Normal BMI >18.5 and < 25
  -Calculation
• BMI < 18.5 = underweight
• BMI 18.5 - 24.9 = Normal
• BMI 25-29.9 = overweight
• BMI 30 - 34.9 = Obesity Class I
• BMI 35 - 39.9 = Obesity Class II
• BMI > 40 = Obesity Class III
• It is beneficial to have a BMI chart in every exam room.

Xray / Diagnositc Tests

Classification / Treatment

• Consider sending all obese patients to Sleep apnea lab pre-operatively or post-operatively for trauma patients.
• Consider having obese patients position themselves on the table while they are awake to decrease risk of injury to surgical staff (hurt backs lifting patients).

Associated Injuries / Differential Diagnosis

• Cardiovascular disease: coronary artery disease, hypertension
• Pulmonary disease
• Sleep apnea / Obstructive sleep apnea (at least five apnea and hypopnea episodes per hour of sleep diagnosed in a sleep laboratory using polysomnography. Obese patients are 6 times more likely to have OSA).
• Higher Mortality rates
• Diabetes

Complications

Follow-up Care

Review References

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