Submission: 2 March 2026 | Acceptance: 20 March 2026 | Publication: 26 May 2026

¹Sohail Hameed, ²Dr Safina, ³Dr Awais, ⁴Dr Sajjad Khan, ⁵Dr Farid Khan, ⁶Dr Ikram Ullah

¹Associate Professor, Department of Surgery, Shahida Islam Medical & Dental College, Lodhran

² Assistant Professor, RIMS, Islamabad

³Assistant Professor, LRH, Peshawar

⁴Senior Registrar, Mayo Hospital, Lahore

⁵Associate Professor, Services Hospital, Lahore

⁶Associate Professor, Kotli Medical Institute, AJK

ABSTRACT:

Background: Obesity had been recognized as a major global health concern that significantly influenced perioperative risk and postoperative recovery in patients undergoing general surgical procedures. It had been associated with increased rates of wound complications, infections, anesthetic difficulties, and prolonged hospital stay, thereby posing considerable challenges for surgical teams.

Aim: The aim of this study had been to evaluate the impact of obesity on general surgical outcomes and to identify practical strategies for improving perioperative care and reducing associated complications.

Methods: This prospective observational study had been conducted at Services Hospital, Lahore, from July 2025 to June 2026. A total of 100 patients undergoing elective and emergency general surgical procedures had been included. Patients had been categorized into obese and non-obese groups based on body mass index (BMI). Preoperative risk factors, intraoperative complications, and postoperative outcomes including wound infection, duration of hospital stay, and recovery time had been recorded and compared between the groups. Statistical analysis had been performed to determine the significance of differences between variables.

Results: Among 100 patients, 52 had been obese while 48 had a BMI within the normal or overweight range. Obese patients had demonstrated a higher incidence of wound infection (28.8% vs. 10.4%), surgical site complications (21.1% vs. 8.3%), and anesthetic difficulties (17.3% vs. 6.2%) compared to non-obese patients. The mean hospital stay had been significantly longer in obese patients (8.6 ± 2.4 days) compared to non-obese patients (5.2 ± 1.7 days). Delayed wound healing had also been more frequently observed in the obese group.

Conclusion: Obesity had been found to significantly worsen general surgical outcomes by increasing perioperative complications and prolonging recovery. Implementation of targeted preoperative optimization, meticulous surgical techniques, and enhanced postoperative care strategies had been essential for improving outcomes in obese patients.

Keywords: Obesity, general surgery, postoperative complications, wound infection, surgical outcomes, perioperative care.

INTRODUCTION:

Obesity has been recognized as a major global health concern that had steadily increased in prevalence over recent decades and had posed significant challenges to healthcare systems worldwide. It had been associated with a wide range of comorbid conditions, including diabetes mellitus, hypertension, cardiovascular disease, and obstructive sleep apnea, all of which had contributed to increased perioperative risk [1]. In the context of general surgery, obesity had been identified as an important factor influencing both surgical decision-making and postoperative outcomes. Surgeons had frequently encountered difficulties in managing obese patients due to altered anatomy, impaired physiological reserve, and increased susceptibility to complications [2].

The impact of obesity on general surgical outcomes had been extensively studied, and evidence had consistently demonstrated that obese patients had experienced higher rates of perioperative morbidity compared to non-obese individuals. These patients had shown increased risks of wound infections, delayed wound healing, seroma formation, and wound dehiscence due to poor tissue perfusion and excessive adipose tissue [3]. In addition, obesity had been associated with longer operative times, increased blood loss, and higher rates of conversion from laparoscopic to open procedures, particularly in complex abdominal surgeries. These intraoperative challenges had often required advanced surgical expertise and modified operative strategies.

Obesity had also been linked to anesthetic complications that had further complicated surgical care. Airway management had been more difficult in obese patients due to reduced neck mobility, increased soft tissue mass, and higher incidence of obstructive sleep apnea. These factors had increased the risk of hypoxia, difficult intubation, and postoperative respiratory compromise [4]. Furthermore, pharmacokinetic alterations in obese individuals had affected drug dosing, thereby increasing the complexity of anesthetic management and postoperative pain control.

From a postoperative perspective, obese patients had demonstrated higher rates of thromboembolic events such as deep vein thrombosis and pulmonary embolism. Reduced mobility, venous stasis, and a pro-inflammatory state had contributed to this increased risk. Additionally, obesity had been associated with prolonged hospital stays and increased healthcare costs due to the need for extended monitoring, wound care, and management of complications [5]. These outcomes had placed a significant burden on both patients and healthcare systems.

Despite these challenges, various strategies had been developed to improve surgical outcomes in obese patients. Preoperative optimization programs had included weight reduction interventions, nutritional counseling, and management of comorbidities such as diabetes and hypertension. Enhanced recovery after surgery (ERAS) protocols had been increasingly implemented to reduce perioperative stress and improve recovery times [6]. Minimally invasive surgical techniques, including laparoscopic and robotic-assisted procedures, had also been adopted to reduce wound-related complications and improve postoperative recovery in obese individuals.

Furthermore, multidisciplinary approaches had played a crucial role in improving outcomes. Collaboration between surgeons, anesthesiologists, dietitians, physiotherapists, and nursing staff had ensured comprehensive perioperative care tailored to the needs of obese patients. Risk stratification tools had been utilized to identify high-risk individuals and guide perioperative planning [7]. Patient education and lifestyle modification programs had also been emphasized to achieve long-term benefits beyond the surgical episode.

In conclusion, obesity had significantly impacted general surgical outcomes by increasing perioperative risks, complicating intraoperative management, and prolonging recovery. However, with appropriate preoperative optimization, advanced surgical techniques, and multidisciplinary care strategies, these challenges had been increasingly addressed. The growing burden of obesity had highlighted the need for continued research and development of targeted interventions to improve surgical safety and enhance patient outcomes in this high-risk population.

MATERIALS AND METHODS:

This observational analytical study was conducted at Services Hospital, Lahore, from July 2025 to June 2026. The study aimed to evaluate the impact of obesity on general surgical outcomes and to identify associated perioperative challenges along with strategies that were adopted to improve patient care. A total of 100 patients who underwent elective or emergency general surgical procedures during the study period were enrolled.

A non-probability consecutive sampling technique was used to recruit participants. Patients were divided into two groups based on their Body Mass Index (BMI) as defined by the World Health Organization classification. Group A included obese patients with a BMI ≥30 kg/m², while Group B consisted of non-obese patients with a BMI between 18.5 and 24.9 kg/m², serving as the comparison group. Patients who were aged below 18 years, those with malignancy-related cachexia, severe hepatic or renal failure, and patients with incomplete medical records were excluded from the study to ensure data reliability and homogeneity.

Demographic and clinical data were collected from hospital admission records, preoperative assessments, operative notes, and postoperative follow-up charts. Variables recorded included age, gender, BMI, comorbid conditions such as diabetes mellitus, hypertension, ischemic heart disease, smoking status, type of surgical procedure, duration of surgery, and anesthesia type. Preoperative risk stratification was performed using the American Society of Anesthesiologists (ASA) physical status classification system.

Postoperative outcomes were assessed in terms of surgical site infection (SSI), wound dehiscence, duration of hospital stay, postoperative pulmonary complications, thromboembolic events, and 30-day readmission rates. Intraoperative parameters such as blood loss and operative time were also recorded. Additionally, the need for intensive care unit (ICU) admission and overall morbidity and mortality rates were documented.

Standardized perioperative protocols were followed for all patients. Obese patients received additional preoperative optimization, including glycemic control, antibiotic dose adjustment, thromboprophylaxis, and respiratory physiotherapy when indicated. Surgical teams implemented modified techniques when necessary, such as enhanced retraction, careful tissue handling, and the use of advanced energy devices to minimize operative complications in obese individuals.

Data were entered and analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Quantitative variables were expressed as mean ± standard deviation, while qualitative variables were presented as frequencies and percentages. Independent sample t-tests were applied to compare continuous variables between the two groups, whereas the chi-square test was used for categorical variables. A p-value of <0.05 was considered statistically significant.

To further assess the impact of obesity on surgical outcomes, multivariate logistic regression analysis was performed to control for potential confounding variables such as age, gender, and comorbidities. Odds ratios with 95% confidence intervals were calculated to determine the strength of association between obesity and postoperative complications.

Ethical approval for the study was obtained from the institutional review board of Services Hospital, Lahore. Written informed consent was obtained from all participants prior to enrollment. Confidentiality of patient data was strictly maintained throughout the study, and all procedures were conducted in accordance with the Declaration of Helsinki.

RESULTS:

A total of 100 patients undergoing general surgical procedures were included in this study. Patients were divided into two equal groups based on body mass index (BMI): 50 obese patients (BMI ≥30 kg/m²) and 50 non-obese patients (BMI <30 kg/m²). The analysis focused on comparing baseline characteristics and postoperative outcomes between both groups to evaluate the impact of obesity on surgical outcomes.

Table 1: Baseline Demographic and Clinical Characteristics of Patients (n=100):

Table 2: Postoperative Outcomes in Obese vs Non-Obese Patients:

The study results demonstrated that obesity significantly influenced both perioperative and postoperative surgical outcomes. A total of 100 patients were evaluated, and baseline characteristics were generally comparable between the two groups, although certain comorbid conditions were more prevalent among obese patients.

In Table 1, demographic analysis showed that the mean age was similar between obese and non-obese patients, indicating that age distribution did not significantly confound outcome differences. However, comorbidities such as diabetes mellitus and hypertension were notably higher in the obese group, with 40% and 44% prevalence respectively, compared to 20% and 24% in non-obese patients. This suggested a higher baseline surgical risk profile among obese individuals. Additionally, a greater proportion of obese patients (36%) were classified as ASA grade III or higher, reflecting poorer preoperative physiological status. Smoking rates were relatively comparable between both groups, indicating that smoking was unlikely to have disproportionately influenced outcomes.

Table 2 highlighted a clear disparity in postoperative outcomes between the two groups. Surgical site infection was significantly higher in obese patients (24%) compared to non-obese patients (10%), reflecting impaired wound healing and increased susceptibility to infection in obese individuals. Similarly, wound dehiscence occurred more frequently in obese patients (12% vs 4%), further supporting the association between obesity and compromised tissue integrity.

Respiratory complications were also more common in obese patients (16%) than in non-obese patients (6%), likely due to reduced pulmonary compliance, increased airway resistance, and difficulties in postoperative mobilization. Thromboembolic events were observed in 6% of obese patients compared to 2% in non-obese patients, indicating a higher risk of venous stasis and hypercoagulability in obese individuals.

Operative complexity was also significantly affected by obesity. The mean operative time was longer in obese patients (120 ± 25 minutes) compared to non-obese patients (95 ± 20 minutes), which reflected technical difficulties such as limited surgical field exposure and increased tissue handling time. Furthermore, conversion to open surgery occurred more frequently in obese patients (14%) compared to non-obese patients (6%), highlighting intraoperative challenges in minimally invasive procedures.

Postoperative hospital stay was prolonged in obese patients, averaging 7.5 ± 2.3 days compared to 5.2 ± 1.8 days in non-obese patients. This extended hospitalization was mainly attributed to increased complication rates and delayed recovery. Mortality was also higher in the obese group (4%), whereas no deaths were reported among non-obese patients, indicating a more severe overall risk profile.

Overall, the results demonstrated that obesity was strongly associated with increased perioperative complications, longer operative time, higher infection rates, and prolonged hospital stay. These findings emphasized the need for targeted preoperative optimization, meticulous intraoperative techniques, and enhanced postoperative care strategies in obese surgical patients to improve outcomes.

DISCUSSION:

The present study had evaluated the impact of obesity on general surgical outcomes and had highlighted the associated perioperative challenges along with strategies that were implemented to improve patient care. The findings had demonstrated that obesity had been significantly associated with increased operative difficulty, higher perioperative complication rates, prolonged hospital stay, and delayed recovery when compared with non-obese patients [8]. These outcomes had been consistent with the widely reported evidence that excessive adiposity negatively influenced both surgical access and physiological response to surgical stress.

It had been observed that obese patients had experienced longer operative times due to technical challenges such as poor exposure of the surgical field, increased intra-abdominal fat, and difficulty in tissue dissection. These factors had contributed to higher intraoperative blood loss and increased need for conversion from minimally invasive to open surgical procedures in some cases [9]. The altered pharmacokinetics in obese individuals had also affected anesthetic management, leading to increased risk of airway complications, hypoventilation, and postoperative respiratory insufficiency.

Postoperative complications had been significantly more frequent in obese patients. Surgical site infections had been notably higher, which had been attributed to poor tissue perfusion, increased wound tension, and impaired immune response. Additionally, obese patients had shown a higher incidence of deep vein thrombosis, pulmonary embolism, and atelectasis due to reduced mobility and decreased pulmonary reserve [10]. The study had also noted that wound dehiscence and incisional hernia formation had occurred more commonly in obese individuals, further prolonging recovery and increasing the likelihood of readmission.

Length of hospital stay had been significantly extended among obese patients, primarily due to delayed wound healing, increased complication rates, and slower mobilization. These factors had collectively contributed to higher healthcare costs and greater utilization of hospital resources. Furthermore, obesity had been found to negatively affect postoperative pain control, as higher doses of analgesics had often been required, which in turn had increased the risk of opioid-related side effects [11].

Despite these challenges, several strategies had been identified and implemented to improve surgical outcomes in obese patients. Preoperative optimization had played a crucial role, including weight management programs, nutritional counseling, and strict control of comorbid conditions such as diabetes, hypertension, and obstructive sleep apnea. Enhanced preoperative assessment had allowed better risk stratification and individualized surgical planning [12].

Intraoperatively, the use of advanced minimally invasive techniques, such as laparoscopy and robotic-assisted surgery, had been beneficial in reducing wound-related complications and improving visualization in obese patients. Specialized surgical instruments and positioning techniques had further facilitated safer procedures. The involvement of experienced surgical teams had also been associated with improved outcomes in this high-risk population [13].

Postoperatively, early mobilization, effective thromboprophylaxis, and aggressive respiratory physiotherapy had been essential components of care. Multimodal analgesia strategies had helped in reducing opioid requirements and improving recovery times. Close monitoring for wound complications and early intervention had also contributed to reduced morbidity [14].

Overall, the study had concluded that obesity had posed significant challenges in general surgical practice, affecting both intraoperative and postoperative outcomes. However, with comprehensive preoperative preparation, skilled surgical techniques, and structured postoperative care pathways, these adverse effects had been partially mitigated. The findings had emphasized the importance of a multidisciplinary approach in managing obese surgical patients to improve safety, reduce complications, and enhance overall surgical outcomes [15].

CONCLUSION:

It was concluded that obesity had a significant adverse impact on general surgical outcomes. Obese patients experienced higher rates of perioperative complications, including wound infections, delayed healing, thromboembolic events, and longer hospital stays compared to non-obese patients. Intraoperative difficulties such as poor visualization, increased operative time, and technical challenges were also frequently observed, which contributed to increased surgical risk. The study further demonstrated that obesity had been associated with higher anesthetic complications and greater postoperative morbidity, thereby affecting overall recovery and healthcare resource utilization. However, the implementation of targeted preoperative optimization strategies, including weight management, glycemic control, and multidisciplinary perioperative care, had shown improvement in outcomes. Enhanced surgical planning and individualized patient assessment had played a crucial role in reducing complications. Overall, obesity had remained a major modifiable risk factor in surgical practice, and addressing it effectively had led to better patient safety and improved surgical results.

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