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

Obesity is a chronic, progressive disease affecting approximately 40% of adults in the United States and now represents a defining characteristic of the emergency general surgery (EGS) population. Accumulating evidence demonstrates that obesity, particularly class III, class IV, and class V obesity, is associated with significantly worse clinical outcomes following emergency surgical intervention, including higher rates of postoperative complications, venous thromboembolism (VTE), respiratory failure, acute kidney injury, prolonged intensive care unit (ICU) and hospital lengths of stay, increased readmissions, and higher mortality. Importantly, many adverse outcomes are not driven by operative mortality alone but by failure-to-rescue following preventable complications. This narrative review critically examines outcome data for obese EGS patients and argues that systematic adoption of bariatric surgery quality frameworks, including standardized pathways for infection prevention, VTE prophylaxis, nutrition, opioid stewardship, and post-discharge follow-up, represents a pragmatic and evidence-based strategy to improve outcomes in this high-risk population.