of Anesthesiologists' Ambulatory Surgical Care Committee.
But how heavily should you weigh a patient's weight-to-height ratio
(BMI = kg/m
2
) when considering whether he's safe for outpatient sur-
gery? Just as there are varying degrees of obesity — a BMI of 25 to
29.9 is considered overweight, over 30 is obese, over 40 is morbidly
obese and over 50 is super obese — BMI alone can't predict operative
risk.
"Many ASCs will default on doing morbidly or super-obese patients
and refer those patients to a hospital," says Dr. Gayer. "But as with all
things, it's advantageous to set a consensus guideline for your facility
that makes the decision binary: yes or no — that's it. If a surgeon is
aware that the center has these fairly hard stops, then he'll book the
patient in a hospital setting."
Fairly hard stops suggests there's a little leeway. Some see a high
BMI as a red flag that danger could lie ahead. Others view it as more
of a sliding scale than a hard-and-fast limit. For example, one facility
might have an absolute BMI cutoff of 50 — "I will do patients on occa-
sion that are above 50, but in general we don't," says Dr. Gayer — and
8 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 1 8
impact. "Cataracts, for example," says Dr. Gayer. "But you might
be more conservative with a laparoscopic procedure in the
abdomen where the patient is insufflated and in steep
Trendelenburg."
• Anesthesia. The anesthesia provider has a long list of con-
cerns, says Dr. Gayer. Will you be able to ventilate the patient?
Intubate and extubate? Ensure adequate oxygenation? "You
have to evaluate all these things pre-operatively," says Dr.
Gayer. "You can't always predict, however, what the risks will
be." — Dan O'Connor
