5 ms·

Surgery isn't riskless. This source shows knee surgery has serious complications in 2% of cases. That's for all patients. But it states the risk of knee fractu

by graeme 10y ago

Surgery isn't riskless. This source shows knee surgery has serious complications in 2% of cases. That's for all patients. But it states the risk of knee fracture is higher for overweight patients. http://www.zimmer.com/patients-caregivers/article/knee/knee-surgery-risks.html http://www.zimmer.com/patients-caregivers/article/knee/knee-... Here's a source specific to overweight patients. Obesity is often comorbid with conditions that make it harder to heal and increase the risk of infection, such as diabetes. http://orthoinfo.org/topic.cfm?topic=A00745 http://orthoinfo.org/topic.cfm?topic=A00745 Here's a crucial section: "However, if you have obesity, you may never achieve the increased mobility and range of motion experienced by a patient of normal weight. You may also experience more implant and prosthesis complications after surgery, including: Component loosening and failure Dislocation of the replacement joint, especially in the hip In some cases, a second "revision" surgery may be necessary to remove failed implants and replace them with new ones. " That section would be based almost purely on weight. Certainly, BMI is a crude measure, and it doesn't work well for weight lifters and athletes. But that's mostly an issue an issue for people near the "overweight" cutoff at 25. The more obese someone gets, the less false positives BMI has. There's clearly an issue where past a certain level of adiposity, knee surgery is not sensible: the risks become high, and the outcomes become poor. What would you do instead? To operate with the expectation of poor outcomes is not good medicine.

lsy 10y ago
From the article: "But there should not be blanket refusals to operate on fat people, the committee wrote. Those with a body mass index over 40 — like a 5-foot-5-inch woman weighing 250 pounds or a 6-foot man weighing 300 — and who cannot lose weight should be informed that their risks are greater, but they should not be categorically dismissed, the group concluded." It's really simple. You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. The article here is not saying that doctors should ignore weight as a factor, but that they shouldn't make decisions to deny or provide care based solely on BMI.
- asynchronous13 10y ago
  "But there should not be blanket refusals to operate on fat people" I don't know anyone who would disagree with this sentiment. And the article doesn't present any evidence that there are blanket refusals. Sure, the article presents a few anecdotes, but that's not enough to show that blanket refusals are happening on a larger scale. > You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. It's really not that simple. A medical doctor's mission is to help people and very specifically to "do no harm". When the data suggests that they are more likely to do harm by operating, then the doctor is following their oath by not performing a surgery.
  - lsy 10y ago
    From the article: "A recent survey of more than 700 hip and knee surgeons confirmed Dr. Yates’s impressions. Sixty-two percent said they used body mass index scores as cutoffs for requiring weight loss before offering surgery." It sounds to me like "cutoffs" and "requiring" would indicate a blanket refusal, and 62% seems like a fairly large scale to me. What evidence are you looking for? Other common conditions can also increase risks of complications, and patients are routinely given opportunities to weigh those risks before deciding on surgeries. My suggestion isn't that the doctor throw his duties out the window, but that with high-BMI patients, those duties should not suddenly become more dictatorial than with other patients.
    - vonmoltke 10y ago
      Some aren't. Patients with severe hypertension, for instance, are often categorically denied non-critical surgeries as well.
    - asynchronous13 10y ago
      There's a difference between saying "You're fat, so we won't operate on you." versus "The pain that you hope to fix will become worse if we perform surgery on you." Surgeries that involve weight-bearing joints and bones are particularly sensitive to the mass of the patient (like the hip and knee surgeons surveyed). For heavier patients, the healing time is longer and the risk of additional pain after surgery is much much higher.

by graeme 10y ago

lsy 10y ago

From the article: "But there should not be blanket refusals to operate on fat people, the committee wrote. Those with a body mass index over 40 — like a 5-foot-5-inch woman weighing 250 pounds or a 6-foot man weighing 300 — and who cannot lose weight should be informed that their risks are greater, but they should not be categorically dismissed, the group concluded." It's really simple. You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. The article here is not saying that doctors should ignore weight as a factor, but that they shouldn't make decisions to deny or provide care based solely on BMI.

asynchronous13 10y ago
"But there should not be blanket refusals to operate on fat people" I don't know anyone who would disagree with this sentiment. And the article doesn't present any evidence that there are blanket refusals. Sure, the article presents a few anecdotes, but that's not enough to show that blanket refusals are happening on a larger scale. > You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. It's really not that simple. A medical doctor's mission is to help people and very specifically to "do no harm". When the data suggests that they are more likely to do harm by operating, then the doctor is following their oath by not performing a surgery.
- lsy 10y ago
  From the article: "A recent survey of more than 700 hip and knee surgeons confirmed Dr. Yates’s impressions. Sixty-two percent said they used body mass index scores as cutoffs for requiring weight loss before offering surgery." It sounds to me like "cutoffs" and "requiring" would indicate a blanket refusal, and 62% seems like a fairly large scale to me. What evidence are you looking for? Other common conditions can also increase risks of complications, and patients are routinely given opportunities to weigh those risks before deciding on surgeries. My suggestion isn't that the doctor throw his duties out the window, but that with high-BMI patients, those duties should not suddenly become more dictatorial than with other patients.
  - vonmoltke 10y ago
    Some aren't. Patients with severe hypertension, for instance, are often categorically denied non-critical surgeries as well.
  - asynchronous13 10y ago
    There's a difference between saying "You're fat, so we won't operate on you." versus "The pain that you hope to fix will become worse if we perform surgery on you." Surgeries that involve weight-bearing joints and bones are particularly sensitive to the mass of the patient (like the hip and knee surgeons surveyed). For heavier patients, the healing time is longer and the risk of additional pain after surgery is much much higher.