More than one quarter of obese patients who have undergone bariatric surgery are unable to get the imaging studies they need in the event of post-operative complications because of their weight.
In a retrospective review of 1188 patients undergoing bariatric surgery between 1999 and 2007 at Massachusetts General Hospital in Boston, Dr. Raul Uppot and colleagues found that 44 patients could not get the imaging necessary for the diagnosis of post-operative complications because of their weight.
These patients weighed 450 pounds or more, with an average weight of nearly 505 pounds. The largest patient weighed 617 pounds.
"The typical scanner table can really only hold 350 pounds," Dr. Uppot told attendees of the 93rd annual meeting of the Radiological Society of North America, being held here this week.
Of these 44 patients, 14 (27 per cent) required further treatment for post-operative complications. Imaging studies could have directed this treatment.
Six patients required another surgery and one of these required five additional surgical procedures, largely due to the delay in diagnosis resulting from a lack of imaging studies. Several more patients were managed medically when surgery might have been the better option, but this would have only been identifiable with imaging.
"Hospitals performing bariatric surgery should have the capability of performing the necessary imaging," Dr. Uppot declared. Being unable to optimally manage more than one quarter of these patients is a serious deficiency, he commented.
"States should look at their obesity prevalence statistics...There should be at least one institution in the state with the capability of doing imaging" for obese patients, he asserted. This would avoid the significant number of potential post-operative problems, such as seen in this study.
Dr. Uppot added that imaging of the obese patient has a wider application, particularly with management of cardiovascular disease. "Angiography is not possible if the patient weighs more than 350 pounds." He said a study will be published in the near future in the
Journal of the American College of Cardiology highlighting this issue.
