1. Where to draw the line on BMI?
BMI cutoffs can range from 35 to 50, with some facilities balancing
BMI with the presence of one or more comorbidities, and others
requiring discretionary approval of patients above certain BMIs by
directors, surgeons and anesthesia providers.
Confounding matters is that there aren't any absolute cutoff stan-
dards for accepting obese patients for surgery at outpatient facilities.
A frequently-cited November 2013 paper in Anesthesia & Analgesia,
"Selection of obese patients undergoing ambulatory surgery: a system-
atic review of the literature" (osmag.net/p9qHQR), concludes that
"the literature lacks adequate information to make strong recommen-
dations regarding appropriate selection of the obese patients sched-
uled for ambulatory surgery." As a result, policies vary from facility to
facility, and from industry organization to industry organization. It's
truly all over the place, but a BMI over 45 appears to push the enve-
lope. Consider:
• An Outpatient Surgery reader poll on BMI cutoff offered no clear
consensus: 35 (13%), 40 (30%), 45 (18%) and 50 (19%). Perhaps most
alarming is that 20% didn't know their facility's BMI limit.
• July 2012 guidelines from Kaiser Permanente
(osmag.net/D4HkFy) advise that outpatient procedures "are appropri-
ate in an ASC setting when … patient weighs less than 400 pounds
with BMI no greater than 45."
• A July 2017 selection criteria policy from Associated
Anesthesiologists, an anesthesia group in Minnesota, says that
patients with a BMI greater than 45 "are not candidates for an anes-
thetic" at an ASC (osmag.net/2CUWdh).
• In a 2016 presentation to the Wisconsin Society of Anesthesiologists,
James Hoell, MD, of the Aurora Sheboygan (Wis.) Memorial Medical
Center, recommended that patients with a BMI between 40 and 50 with
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