Perhaps contrary to what you might think, previous research had found that obese patients undergoing non-cardiac surgery had a lower risk of death and complications following surgery, which was known as the obesity paradox. It appeared that obesity provided a protective effect under certain circumstances.
In a new study, researchers divided obese patients into two groups: one group without metabolic syndrome (that is, obese but healthy) and the other group with metabolic syndrome with certain specified medical conditions (specifically, patients with diabetes and hypertension). Since it is easy to determine if a patient has diabetes and/or hypertension, it was easy to assign patients into one of the two groups.
Patients are considered to have metabolic syndrome if they have have three or more of the following risk factors: high blood pressure, glucose intolerance or diabetes, abdominal obesity (being apple-shaped), increased triglycerides (fats in the blood), and low levels of good HDL cholesterol. About 22% of the adult population in the U.S. have metabolic syndrome.
The researchers found that obese patients with diabetes and hypertension had a substantially greater risk for cardiac (heart) complications (2 to 3 times higher risk), pulmonary (lung) complications (1.5 to 2.5 higher risk), kidney complications (some 3 to 7 times the risk), and neurological complications (2 times higher risk) 30 days after surgery. The risk of death did not increase except for patients who were super obese.
What is the significance of the study? Obese people are not all alike simply because they are obese. You can be obese and otherwise healthy. However, if you are obese and have diabetes and hypertension, then your risk for complications following non-cardiac surgery is much greater. Surgeons and anesthesiologists can now plan surgery more carefully for obese patients with diabetes and hypertension.
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