Anesthesia for non-cardiac surgery in obese patients in a secondary hospital located in an urban-rural area: a retrospective cohort study

Edwige Mombeleke; Wilfrid Mbombo; Arriel Makembi Bunkete; Alphonse Mosolo; Freddy Mbuyi; Rémy Kashala; Paul Kambala; Trésor Mapangula; Kazi Anga; Pascal Bayauli; Jean-bosco Kasiam; Aliocha Nkodila; Emmanuel Namegabe; Didier Djekembo; John Nsiala; Médard Bulabula; Berthe Barhayiga

doi:10.5455/JSRR.20260303084320

Abstract
Background and Objective. Anesthesia in obese patients is associated with increased morbidity and mortality, but has never been studied in our setting. This study investigated associated complications according to obesity grade.
Methods. This was a retrospective cohort study conducted from January 2011 to December 2024 at Monkole Hospital. Perianesthetic data from all obese adult patients anesthetized for non-cardiac surgery were collected and analyzed with SPSS 26.0 using appropriate statistical tests for p < 0.05. Ethical guidelines were respected.
Results. Of 13,226 anesthetized patients, 1,668 were obese (12.6%), including 1,162 (69.7%) moderately obese, 384 (23%) severely obese, and 122 (7.3%) morbidly obese. Cardiovascular comorbidities, difficulties with intubation and venous access, and hyperglycemia predominated in the morbidly obese. Major surgery, general anesthesia with intubation, propofol, and suxamethonium were significantly more commonly used in the morbidly obese patients. Intraoperative complications were more frequent in morbidly obese ORa 2.98(2.29-3.86) and influenced by Mallampati grades II to IV ORa 1.63(1.06-2.66), ASA4 class ORa 2.55(1.06-6.24) and major surgical procedure ORa 2.70(2.06-3.55). Obesity grade was not associated with mortality or postoperative complications, which included the following factors: the presence of a history of hematological disease (ORa 2.79 (1.7-3.78), ASA class 4 (ORa 3.09 (1.32-9.28), severe anemia (ORa 3.12 (2.11-4.21), hyperglycemia (ORa 3.92 (1.27-5.07), and major surgery (ORa 2.88 (1.84-3.85).
Conclusion: This study shows that obese patients of all grades benefit from anesthetic procedures in our setting, and we need to improve their management. Intraoperative complications are more frequent in cases of morbid obesity, requiring us to double our attention in this type of patient.

Key words: Anesthesia, obesity, non-cardiac surgery, urban-rural setting