Patients With Obesity on the Acute Care Surgery Service: Improving Outcomes

Area of Science:

• Surgical outcomes research
• Obesity medicine
• Public health

Background:

• Obesity affects 40% of US adults and is prevalent in emergency general surgery (EGS) patients.
• Severe obesity (class III-V) is linked to worse outcomes, including higher complication rates, venous thromboembolism (VTE), respiratory failure, acute kidney injury, and mortality.
• Adverse outcomes are often due to failure-to-rescue from preventable complications.

Purpose of the Study:

• To review outcome data for obese EGS patients.
• To propose evidence-based strategies to improve care for this population.

Main Methods:

• This is a narrative review examining existing outcome data for obese EGS patients.
• The review critically analyzes the association between obesity and surgical outcomes.
• It proposes the adoption of bariatric surgery quality frameworks.

Main Results:

• Obesity, especially severe classes, is associated with significantly worse clinical outcomes in EGS.
• These include increased postoperative complications, VTE, respiratory failure, acute kidney injury, and prolonged hospital stays.
• Higher mortality and readmission rates are observed in obese EGS patients.

Conclusions:

• Systematic adoption of bariatric surgery quality frameworks is a pragmatic strategy to improve outcomes.
• Standardized pathways for infection prevention, VTE prophylaxis, nutrition, opioid stewardship, and follow-up are recommended.
• Implementing these frameworks can mitigate adverse outcomes in high-risk obese EGS patients.