Bariatric Times

SEP 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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11 Review and Case Study Bariatric Times • September 2017 a bility to provide reasonable care or intervention. This important study suggests that when caregivers have resources necessary to perform tasks the extent of sensitivity t oward the individual who has morbid obesity increases. Those areas in the Kaminisky and Gadelenta study that did not have access to necessary tools (e.g., e quipment) and resources (e.g., support personnel) held weight bias to a greater extent. 15 Drake et al present similar findings as they explain that having access to s pecialized equipment was significantly related to satisfaction for those working in in-patient facilities; over 97 percent of those who reported satisfying experiences a lso had access to specialized equipment. 16 In contrast, 68 percent of those reporting an unsatisfactory experience did not have access to specialized equipment. E ven the most compassionate caregiver mighty be reluctant to provide adequate care to a patient with obesity because of the threat of physical injury to themselves. 17,18 The fear of injury is realistic and, combined with the failure to provide satisfactory care to a complex patient, further perpetuates discrimination toward the patient with obesity. 19,20 CLINICAL COMPLEXITIES A high degree of adiposity affects every cell, every organ, and every system of the body, as well as morbidity and mortality. 21 In many cases, this in turn impacts the ability for healthcare providers to deliver equitable care. Standard healthcare policies and procedures might not serve the needs of the individual who has overweight, obesity, or morbid obesity. 2 2 Studies suggest that the person with a high degree of adiposity will present with an average of 2.6 significant comorbid conditions, which might include cardiac disease (associated with left ventricular hypertrophy), hypertension, insulin resistance/diabetes, dyslipidemia, obesity hypoventilation syndrome (associated with right-sided heart failure), and more. 23 As more acute care facilities struggle with prevention of the nonreimbursable events as described by Centers for Medical and Medicare (CMS), bariatric patient care continues to gain attention. For instance, nonreimbursement, penalties, fines, and claims associated with avoidable Stage 3 and 4 pressure injury or surgical site infection are two areas of concern. 24 An individual with a high degree of adiposity is at greater risk for skin injury simply because of skin changes associated with increased adiposity. 25 For instance, Chen et al 26 explain that performing surgical procedures on individuals who have m orbid obesity usually takes longer, the operating fields are deeper, the spaces in which an infection can develop are often greater, and blood flow in adipose tissue is less than in other types of tissue. Consequently, this can lead to s lower healing and places the patient at risk for hematoma, surgical site infection, and/or increased length of stay. 27 From a pressure injury perspective, Cai et al 28 determined a s ignificant increase in pressure injury development among patients with obesity compared to patients without obesity. Although specific analytics pertaining to cost An acute hospital stay that involves pressure injury might incur additional charges of up to $700,000. Treatment costs for a Stage 3 pressure injury can range from $5,900 to $14,840; treatment of a Stage 4 might cost between $18,300 and $21,410. 31

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