Unoptimised obesity, OSA, and DM for gynae surgery

50 year old female for Laparoscopic salpingo-oopherectomy +/- laparotomy +/- mirena exchange. Multi-loculated ovarian mass on US.

Phone consultation.


  1. Morbid obesity – BMI 48
  2. OSA – tested 6 years ago, not requiring CPAP, however now 25 kg heavier
  3. Diabetes – poor control HbA1c 14%
  4. Smoker – 20 per day.
  5. Asthma – uses Ventolin once per month. No hospital admissions.


  1. Diabetes optimization – was referred to rapid access
  2. OSA – likely worse now. However limited time to optimize prior to surgery.
  3. Smoking – advised to stop


  • How long to wait to optimize patient. This patient has many potentially modifiable preoperative risk factors. However following discussion with surgeons, they recommended a maximum delay of 1 month to optimize conditions, in order to avoid potential progression of disease.
  • Attempt made to reduce smoking and optimize diabetes. Patient commenced on opti-insulin (old Lantus). Poorly compliant and limited interation with Rapid access diabetes service.
  • ICU post operatively. Note previous OSA at lower weight not requiring CPAP. Uncertain invasiveness of procedure. At this stage listed as ICU3 – ie potential for ICU, however not requiring ICU bed prior to starting surgery. Note attached guide on management post operatively for those patients with known OSA. Ideal location post-operatively is with respiratory monitoring (RR and SaO2). ICU may be excess to needs, however is only option in current JHH set up.