Poor cardio fitness increases complications

Patients with low fitness levels could be at higher risk of complications after bariatric (obesity) surgery, a study has shown.

Research published in Chest, the journal of the American College of Chest Physicians (ACCP), has revealed that morbidly obese patients with low levels of cardiopulmonary fitness spend longer in theatre when undergoing obesity surgery and are more likely to experience post-operative complications.

Dr Peter McCullough of William Beaumont Hospital in Michigan said that random complications do sometimes occur during obesity surgery.

"However, complications may become more apparent in patients with low levels of cardiopulmonary fitness, because they have very little pulmonary reserve and have reduced ability to withstand surgery," he explained.

The study involved 109 morbidly obese patients, all of whom underwent gastric bypass surgery.

Those patients who had the highest body mass index (BMI) and the lowest cardiopulmonary fitness were seven times more likely to experience primary complications, such as permanent or potential organ damage, than those with lower BMIs and higher fitness levels.

In total, 16.6 per cent of patients with low fitness levels experienced complications such as unstable angina, deep vein thrombosis, pulmonary embolism, renal failure, stroke or death, compared with just 2.8 per cent of patients with higher fitness levels.

In addition, those patients with low cardiopulmonary fitness spent on average 24.8 minutes longer in surgery than other patients and were required to stay in hospital for longer.

However, patients should not necessarily be deterred from undergoing obesity surgery, Dr McCullough claimed.

"Bariatric surgery has been shown to reduce co-morbidities and long-term mortality in morbidly obese patients," he said. "The benefits of bariatric surgery clearly outweigh the risks."

Patients with low cardiopulmonary fitness are therefore advised to attempt a combination of medical weight loss and physical conditioning prior to obesity surgery in order to decrease the chances of postoperative complications.

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