Literature has suggested that obese (BMI >30) and morbidly obese (BMI > 35) patients should not be offered surgery as a day case due to increases in complication and readmission rates. At Torbay hospital, patients are routinely offered day case surgery, in a specialist day case unit, regardless of BMI. This is done with minimal complications and enables a higher throughput of patients and at least 75% of surgical procedures to be performed as a day case, as per NHS guidelines.

We present 12 year data of day case knee arthroscopy surgery performed at Torbay hospital. Over 12 years, 3421 knee arthroscopies were performed. 649 were performed on obese patients and 222 on morbidly obese patients. No anaesthetic complications were observed in any of the obese patient groups and readmissions rates (up to 28 days) were 0.8% in the morbidly obese group and 0.9% in the Obese group, compared to 0.9% for patients with BMI <30.

Our data shows that day case surgery can be performed on all patients regardless of BMI and patient obesity. We believe that other units should offer surgery to obese and morbidly obese patients to allow increased efficiency and achievement of NHS day case guidelines.

Background

During cephalomedullary nail stabilisation of subtrochanteric femoral fractures, damage to the distal anterior femoral cortex by the nail is a recognised cause of periprosthetic fracture. Currently available cephalomedullary devices vary widely in anteroposterior curvature, though all are less curved than the mean anatomic human femur. This study tests the hypothesis that a cephalomedullary device with greater anteroposterior curvature will achieve a more favourable position in the distal femur, with greater distance of the nail tip from the anterior cortex, and therefore lower risk of cortical damage.