Evaluation on Pre-Operative Management of Obese Patients 

Introduction: 
At Queen Elizabeth Hospital Birmingham (QEHB), patients are triaged into consultant-led High Risk (Level 2B and 3) or nurse-led Low Risk (Level 1 and 2A) pre-operative assessment (PAS) clinics, according to patient’s comorbidities.  However, there are no specific guidelines to triage patients based on their body mass index (BMI) for PAS clinics. Our aim was to evaluate pre-assessment screening of obese patients at QEHB.
Methods: 
We carried out a service evaluation of PAS of obese patients (>30kg/m2) undergoing elective general surgery from March 2015 to May 2015 at QEHB. Primary outcome was to measure the level of triage according to patients BMI. Secondary outcome measures were complication rates, cancellations, post-operative care setting and length of hospital stay. Multivariate regression was carried out to identify risk factors of post-operative complications and length of hospital stay in these patients. 
Results:
A total of 139 patients were included in our analysis. There was no difference of mean BMI between the groups. Older patients were more likely to be in the high risk clinics and this was statistically significant between groups (F = 5.31, p = 0.002). Length of hospital stay increases linearly with increasing levels of levels of pre-op assessment (F= 18.11, p < 0.0001). Complication rates in our cohort were 15.8% of which 47.6% were from Level 3 but this was not statistically significant between the different groups ( = 7.22, p = 0.065). With multivariate regression analysis, we found increasing rates of complications (p = 0.006) and longer length of hospital stay (t = 3.92, p< 0.0001) with increasing surgery grade. There was no significant difference in rates of cancelations between the low and the high risk groups (χ = 0.55, p = 0.814). High risk patients were likely to be sent to the wards/Intensive Care Unit (ICU) than low risk patients following surgery (OR: 8.20; 95% CI: 3.46 - 19.44; p < 0.0001)
Conclusions:
Surgery grade was found to be an independent risk factor of length of hospital stay and complication rates. The use of BMI as a independent risk factor for pre-assessment level is not justified from our cohort. However, further prospective studies are required to validate our findings.

Evaluation on pre-operative assessment of obese patients