Guideline No. 386-Gynaecologic Surgery in the Obese Patient

Objective: To provide gynaecologic surgeons with a contemporary review on the pre-, intra-, and postoperative issues of the obese patient and to provide guidance for optimization and strategies for safer surgical care. Intended Users: Physicians, including gynaecologists, family physicians, general surgeons; nurses, including registered nurses and nurse practitioners; medical trainees, including medical students, residents, and fellows; and all other health care providers. Target Population: Adult women (18 years and older) meeting criteria for obesity (body mass index >= 30) and undergoing gynaecologic surgery. Outcomes: Physiologic changes and comorbid conditions associated with obesity; the evidence for the impact of obesity on gynaecologic surgery; and preoperative, intraoperative, and postoperative interventions to reduce risk. Evidence: For this guideline, relevant studies were searched in the PubMed, EMBASE, Medline, and Cochrane databases. MeSH search terms included Gynecology, Obesity, Obesity/morbid, Overweight, Body mass index, Surgery, Laparoscopy, Laparotomy, Anesthesia, Intraoperative complications, Postoperative complications, Morbidity, and Mortality. Validation methods: The content and recommendations were drafted and agreed upon by the principal authors and members of the Gynaecology Committee. The Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework. Benefits, Harms, and Costs: Obesity affects 1 in 5 Canadian adults. This guideline outlines strategies to improve outcomes in obese women undergoing gynaecologic surgery. Guideline Update: This SOGC clinical practice guideline will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/ long based on their expert knowledge of the subject matter.