ABSTRACT
Successful preoperative evaluation requires a careful teamwork and communication between the patient, surgeon, primary care physician, anesthesiologist, and consultants. The initial history forms the most important part of this evaluation and serves as a screen for conditions that can adversely affect outcome. Morbidly obese patients should be assessed for risk of cardiac disease before elective surgery. In the absence of other comorbidities, obesity can cause changes in cardiac structure and function (1). Chronic hypervolemia, elevated cardiac output, and elevations in vascular resistance contribute to left ventricular hypertrophy (LVH), which is a predisposing factor for arrhythmias and ischemia. Although it is well known that morbid obesity increases risk for cardiac disease, there is no data to demonstrate a direct risk for increased perioperative cardiac complications. In a large cohort of obese patients having elective general surgery, obesity alone was not predictive of increased perioperative morbidity, complications, or additional use of medical resources (2). Unfortunately, bariatric patients were excluded from this study and severe obesity was defined as a body mass index greater than 35; so it is unclear if these results could be extrapolated to the bariatric population. There are conflicting studies regarding the effect of obesity on intensive care unit (ICU) mortality.
However, two large studies agree that medical ICU mortality is significantly higher in morbidly obese groups (3,4). Increased perioperative morbidity associated with obesity includes wound infection, pneumonia, pulmonary embolism, and cardiac ischemia and failure.
