High risk surgery
Deteriation post operatively
There are times when ‘saying no’ to medical treatment is safer than saying ‘yes’.
Morbid obesity and surgery don’t mix.
An morbidly obese woman in her sixties called ‘Maria’ had difficulty walking.
She had been diagnosed with advanced arthritis in both her knees, was told she needed joint replacements.
Maria was assessed as a suitable candidate for surgery.
Maria sat on the hospital waiting list for eighteen months. While vague references were made to her weight by the surgical team who assessed her, she was never told directly that she must lose weight.
No referral was made to a dietitian.
The hospital did not have a pre surgical checklist, assessing people’s height to weight ratio. Maria asked no questions of her doctors. She passively accepted what she was told and waited for surgery.
Despite the risks for a morbidly obese patients, the surgical team decided to do both knee replacements at the same time.
After surgery Maria’s wounds were slow to heal. She had extreme difficulty getting out of bed, due to her weight and pain from surgery.
She was not able to do deep breathing and coughing, to clear her lungs. Ward staff found it difficult to coordinate the nurses, physiotherapists and attendants needed to help mobilise her.
So Maria stayed in bed, day after day. Her wounds oozed slowly but continuously.
Despite this, she was not assessed as a post surgery risk.
No special measures were taken to quickly improve her general health.
Maria remained chronically unwell for several weeks. She complained of severe pain and a had a constant low grade temperature.
Nursing staff found a hoist from another ward, and physio’s began to get her out of bed for one hour every day.
Her oxygen levels remained ordinary and blood pressure remained low. Maria didn’t feel like eating. She complained all the time. Staff began to get frustrated with the effort involved in mobilising her.
After a week her knee dressings came down and the surgical team was not happy with the results. Both knee wounds was still wet, with a constant haemoserous ooze. Her surgical sites were swabbed. When the results came back that she had an infection, oral antibiotics were prescribed.
With each new change of nursing staff, Maria’s dressing regime was changed. Documentation of the progress of her wounds was extremely poor, just a series of nurses rudimental drawings. There was no systematic approach to her wound management. Her surgical wounds were not photographed, or measured with a ruler.
Nursing staff could see that Maria was going to be an inpatient for a long time.
They ordered an air bed to make sure she didn’t get a pressure ulcer.
Then they organised to get her out of the surgical ward, and into a medical ward.
Three weeks after the surgery Maria’s became unwell sitting out of bed. Her blood pressure dropped so low that she fainted.
Staff flew into a panic. She was revived, fluids and antibiotics were started and a large team of people got her back on to the bed.
She was reviewed by the medical team and assessed as being dry from lack of fluids and overwhelmed with an infection.
Intravenous antibiotics were started and the wound was re swabbed.
Nursing staff refused to get her out of bed again.
Maria lay on her back, moaning about the pain, not eating or drinking. Her knee wounds continued to slowly ooze.
Six weeks after surgery, while on a medical ward Maria went into cardiac arrest. She was taken to Intensive Care and assessed as having a severe infection.
Maria stayed in Intensive Care for several days, then returned to the medical ward.
Her surgical team did not often see her. The medical ward did not have a physiotherapy team. Maria was allowed to lie in bed every day. She continued to deteriorate.
Eight weeks after the surgery, Maria had her second cardiac arrest. She was taken back to Intensive Care, and assessed as being in septic shock. She failed to recover.
Nine weeks after doing a bilateral knee replacements on an elderly, morbidly obese woman, the patient died in hospital.
The hospital did not introduce pre screening or post surgery checklists.
© Wikihospitals 2014
Surgery Risks Higher for Obese – WebMD