Routine surgery for very overweight patients

There is strong clinical evidence that obese patients undergoing surgery are at significantly higher risk of getting infections and suffering heart, kidney and lung problems than people who are a healthy weight.  They are also likely to have to spend more time in hospital recovering and their risk of dying as a result of surgery is higher compared to patients with a normal weight.

So GPs in Hertfordshire are asking very overweight patients to lose weight before they can be listed for routine (non urgent) surgery.

Dr Tony Kostick, Chair of East and North Herts Clinical Commissioning Group said, “There are a number of things that contribute to the success of a procedure carried out under anaesthetic.  An important one of these is to be a healthy weight and another is to be a non smoker. 

“There is always a risk when patients are given an anaesthetic but there is strong clinical evidence that proves that this risk is significantly higher whey they are overweight and if they smoke.  These patients are much more likely to suffer serious breathing problems, get infections, have heart, kidney and lung complications.  It also takes them longer to recover and they have a higher risk of dying under anaesthetic.

“So for these health reasons in this area patients will not be booked for routine surgery until they have lost weight.  A relatively small weight loss can reduce the risks of surgery quite dramatically and we will be looking for that first, but the more you lose the better it will be - not just for when you have surgery but for long term good health.  You will reduce the risk of getting some really serious conditions like diabetes, heart disease, stroke, cancer and liver problems.  And being overweight also has a significant effect on life expectancy.  Severely obese people can expect to die an average of 11 years earlier than those with a healthy weight. "

Dr Nicholas Small, Chair of Herts Valleys Clinical Commissioning Group added, “GPs and practice nurses can provide information on what support is available to help patients to lose weight before surgery and to continue with their weight loss afterwards.

“The measures we are introducing in Hertfordshire are for people who need routine (planned) surgery only.  They do not apply when people need urgent or emergency surgery such as to treat cancer.  There will also be times when it will be appropriate to offer surgery to a patient without following these measures. 

"As well asking patients to lose weight before routine surgery, GPs will also ask smokers to attend an appointment with a specialist stop smoking adviser who will explain the support that is available to help them quit. The specialist will make sure that the patient is fully aware of all the benefits of becoming a non-smoker and the particular risks that surgery presents for people who smoke. This will mean that patients will be in a better position to make an informed decision about stopping smoking before surgery.  Doctors agree that the best thing that people can do for their long term good health is to quit smoking."

Notes for editors:

Clinical commissioning groups are led by local GPs who will become responsible for commissioning (or buying) health services for local people once primary care trusts are abolished at the end of March 2013.

Hertfordshire has two large clinical commissioning groups who both gained 'pathfinder' status in 2011.  They now have fully elected boards that are sub-committees of the PCT Board.

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