A perioperative care map improves outcomes in patients with morbid obesity undergoing major surgery

Background: The surgical management of patients with morbid obesity (BMI ≥ 40) is notable for a relatively high risk of complications. To address this problem, a perioperative care map was developed using precautions and best practices commonly employed in bariatric surgery. It requires additional medical assessments, sleep apnea surveillance, more stringent guidelines for anesthetic management, and readily available bariatric operating room equipment, among other items. This care map was implemented in 2013 at four major urban teaching hospitals for use in patients undergoing all types of non-ambulatory surgery with a BMI greater than 40 kg/m². The impact on patient outcomes was evaluated. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was used to compare 30-day outcomes of morbidly obese patients before (2013) and after (2015) care map implementation. In addition, trends in 30-day outcomes for morbidly obese patients were compared to those for non-obese patients. Results: Morbidly obese patients, between 2013 and 2015, saw an adjusted decrease in the rate of unplanned return to the operating room (OR = 0.49; P= .039), unplanned readmission (OR = 0.57; P = .006), total length of stay (LOS) (-0.87 days; P = .009), and postoperative LOS (-0.69 days; P = .007). Of these, total LOS (-0.86 days; P = .015), and postoperative LOS (-0.69 days; P = .012) improved significantly more for morbidly obese patients than for non-morbidly obese patients. Conclusion: Outcomes in morbidly obese patients improved from 2013 to 2015. Implementation of a perioperative care map may have contributed to these improvements. The care map should be further investigated and considered for more widespread use.