Obesity related complications in surgery.
OBJECTIVE
This article aims to review relevant implications of obesity and associated comorbid conditions for the otology and neurotology surgical subspecialties.


RESULTS
Both the incidence and prevalence of obesity are rising worldwide. This condition, along with its many associated comorbidities, can adversely affect the perioperative management of patients undergoing otologic and neurotologic procedures. Preoperative assessment of the cardiopulmonary system and airway are imperative as compromise of either may lead to death. Physiologic changes found in patients with obesity have been shown to predispose to hemodynamic instability, intolerance of hypoxia, bleeding, thrombo-embolism, poor wound healing, and decreased drug clearance. An 'obesity paradox' may exist in which patients who are overweight or obese may have less perioperative morbidity and mortality. Patients who are underweight or morbidly obese seem to have worse surgical outcomes. Obesity has been associated with intracranial hypertension, risk of cerebrospinal fluid (CSF) leak recurrence, and skull base erosion leading to multiple pathologic conditions. These include spontaneous CSF otorrhea, semicircular canal dehiscence syndrome, and sigmoid sinus diverticulum.


CONCLUSIONS
The obese habitus and physiology significantly affects patients undergoing otologic and neurologic surgeries. A thorough understanding of this condition is paramount to successful outcomes.
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Shawn M
SM
Stevens
Brendan P
BP
O'Connell
Ted A
TA
Meyer
D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D009765:Obesity / Q000150:complications* / Q000503:physiopathology*; D013506:Otologic Surgical Procedures / Q000009:adverse effects*