Quantifying a care gap in BC: Caring for surgical patients with a body mass index higher than 30.

Background: Obesity rates are on the rise in British Columbia, in Canada, and throughout the world. Because obesity is associated with many well-documented comorbidities and perioperative complications, surgical and anesthetic management of obese patients is challenging and resource-intensive. An obesity guideline from the College of Physicians and Surgeons of British Columbia considers the suitability of patients for surgery at nonhospital medical facilities in terms of three body mass index (kg/m2) categories. Patients with a BMI of 30 to 34.9 are considered suitable surgical candidates only if they have no more than two comorbid conditions; patients with a BMI of 35 to 38 should have only minor peripheral procedures with regional or local anesthesia; and patients with a BMI higher than 38.1 should have surgery only "under extraordinary situations." These recommendations mean that some obese patients may not have access to the surgical care they require--a potential care gap that we set out to quantify by surveying BC surgeons and anesthesiologists. Methods: A questionnaire was developed to find out about the surgical care of obese patients based on three risk stratification categories: BMI 30 to 34, 35 to 37, and 38 or higher. The questionnaire was distributed via e-mail invitation to BC associations representing general surgeons, orthopaedic surgeons, obstetrician/gynecologists, and anesthesiologists. SurveyMonkey was used to collect and analyze the responses. Results: A total of 377 respondents completed the survey: 154 surgeons (53 general surgeons, 57 orthopaedic surgeons, and 44 obstetrician/ gynecologists) and 223 anesthesiologists. All six health authorities in British Columbia were well represented. All surgeons and almost all anesthesiologists (97%) indicated that they provide care for obese patients. Anesthesiologists indicated that they modify their management of patients based on a BMI of 30 to 34 (72%), 35 to 37 (98%), and 38 or higher (100%). Of the surgeons surveyed, 85% acknowledged that patients at their hospitals have had surgery postponed or cancelled because of obesity and either had to leave the community for their care or go without care, and 68% indicated that they have cared for obese patients at some point in their careers whose surgery had been postponed or declined by another provider. Regarding elective surgery, surgeons delayed or declined to perform surgery because of concerns about obesity-related complications in patients with a BMI of 30 to 34 (77%) and in patients with a BMI of 38 or higher (96%). Regarding urgent surgery, surgeons delayed or declined to perform surgery in patients with a BMI of 30 to 34 (31%) and in patients with a BMI of 38 or higher (60%). When surgeons were asked if they thought their hospitals could become centres of excellence for managing obese surgical patients, 73% felt this would be possible with the adequate resources to allow for the extra time, skill, and effort needed for safe care of these complex patients. Conclusions: Survey responses revealed a significant care gap existing in BC. A number of patients are waiting for or being denied surgical care because of concerns about their obesity. It is notable that 96% of surgeon respondents have delayed or declined to perform elective surgery in patients with a BMI higher than 38, and that 60% of surgeon respondents have delayed or declined to perform urgent surgery in patients with a BMI of 38 or higher. There is a clear need for provincial centres of excellence to support the work of surgeons and anesthesiologists with an interest in treating these patients and achieving better patient outcomes with the use of evidenceinformed protocols and increased volume and provider experience. [ABSTRACT FROM AUTHOR]