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Rationing elective surgery for smokers and obese patients: responsibility or prognosis?

Published on Dec 1, 2018in BMC Medical Ethics2.51
· DOI :10.1186/s12910-018-0272-7
Virimchi Pillutla1
Estimated H-index: 1
(Monash University, Clayton campus),
Hannah Maslen9
Estimated H-index: 9
(University of Oxford),
Julian Savulescu45
Estimated H-index: 45
(University of Oxford)
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Abstract
Background In the United Kingdom (UK), a number of National Health Service (NHS) Clinical Commissioning Groups (CCG) have proposed controversial measures to restrict elective surgery for patients who either smoke or are obese. Whilst the nature of these measures varies between NHS authorities, typically, patients above a certain Body Mass Index (BMI) and smokers are required to lose weight and quit smoking prior to being considered eligible for elective surgery. Patients will be supported and monitored throughout this mandatory period to ensure their clinical needs are appropriately met. Controversy regarding such measures has primarily centred on the perceived unfairness of targeting certain health states and lifestyle choices to save public money. Concerns have also been raised in response to rhetoric from certain NHS authorities, which may be taken to imply that such measures punitively hold people responsible for behaviours affecting their health states, or simply for being in a particular health state.
  • References (22)
  • Citations (3)
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References22
Newest
Published on Mar 1, 2016in Surgery for Obesity and Related Diseases3.76
Peter Gerber5
Estimated H-index: 5
(KI: Karolinska Institutet),
Claes Anderin4
Estimated H-index: 4
(KI: Karolinska Institutet)
+ 1 AuthorsAnders Thorell46
Estimated H-index: 46
(KI: Karolinska Institutet)
Abstract Background Weight loss before bariatric surgery has been found to be associated with reduced rates of postoperative complications. Objective To evaluate whether preoperative weight loss was also associated with improved postoperative weight loss over time and if this was dependent on preoperative body mass index (BMI). Setting Data from the Swedish national registry for bariatric surgery. Methods Out of 20,564 patients undergoing primary gastric bypass from January 1, 2008 to November 3...
Published on Feb 1, 2015in Journal of Medical Ethics2.19
Andreas Albertsen4
Estimated H-index: 4
Eli Feiring has developed a concept of forward-looking responsibility in healthcare. On this account, what matters morally in the allocation of scarce healthcare resources is not people9s past behaviours but rather their commitment to take on lifestyles that will increase the benefit acquired from received treatment. According to Feiring, this is to be preferred over the backward-looking concept of responsibility often associated with luck egalitarianism. The article critically scrutinises Feiri...
Published on Sep 10, 2014in CA: A Cancer Journal for Clinicians223.68
Roland Sturm50
Estimated H-index: 50
(AN: RAND Corporation),
Ruopeng An19
Estimated H-index: 19
(UIUC: University of Illinois at Urbana–Champaign)
This review summarizes current understanding of economic factors during the obesity epidemic and dispels some widely held, but incorrect, beliefs. Rising obesity rates coincided with increases in leisure time (rather than increased work hours), increased fruit and vegetable availability (rather than a decline in healthier foods), and increased exercise uptake. As a share of disposable income, Americans now have the cheapest food available in history, which fueled the obesity epidemic. Weight gai...
Published on Mar 27, 2014in Cochrane Database of Systematic Reviews7.75
Thordis Thomsen11
Estimated H-index: 11
,
Nete Villebro6
Estimated H-index: 6
,
Ann Merete Møller35
Estimated H-index: 35
(UCPH: University of Copenhagen)
Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. The objective of this review was to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively and on the incidence of postoperative complications.
Published on Mar 1, 2014in Journal of Arthroplasty3.52
Maria C.S. Inacio33
Estimated H-index: 33
(UCSD: University of California, San Diego),
Donna Kritz-Silverstein43
Estimated H-index: 43
(UCSD: University of California, San Diego)
+ 4 AuthorsDonald C. Fithian32
Estimated H-index: 32
Abstract This study characterized a cohort of obese total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients (1/1/2008–12/31/2010) and evaluated whether a clinically significant amount of pre-operative weight loss (5% decrease in body weight) is associated with a decreased risk of surgical site infections (SSI) and readmissions post-surgery. 10,718 TKAs and 4066 THAs were identified. During the one year pre-TKA 7.6% of patients gained weight, 12.4% lost weight, and 79.9% remained ...
Published on Jan 1, 2014in Annals of Surgery9.48
Marie Grønkjær2
Estimated H-index: 2
,
Marie Eliasen6
Estimated H-index: 6
+ 5 AuthorsTrine Flensborg-Madsen11
Estimated H-index: 11
Published on Aug 1, 2012in Journal of Public Health1.65
Rosemary Hiscock25
Estimated H-index: 25
(University of Bath),
Linda Bauld30
Estimated H-index: 30
(University of Stirling)
+ 1 AuthorsStephen Platt7
Estimated H-index: 7
(Edin.: University of Edinburgh)
Background Since 2000 various tobacco control measures have been implemented in the UK. Changes in the smoking status of low and high socioeconomic status (SES) groups in England during this period (2001–08) are explored. Methods Secondary analysis of the Health Survey for England general population samples was undertaken. Over 88 000 adults, age 16 or over, living in England were included. Smoking status (current, ex or never) was reported. SES was assessed through a count of seven possible ind...
Published on Dec 1, 2011in Journal of Public Health1.65
Peter Scarborough43
Estimated H-index: 43
(BHF: British Heart Foundation),
P Bhatnagar14
Estimated H-index: 14
(BHF: British Heart Foundation)
+ 3 AuthorsMike Rayner47
Estimated H-index: 47
(BHF: British Heart Foundation)
Background Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992–93. Methods Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attri...
Published on Jun 13, 2011in JAMA Internal Medicine20.77
Katie Myers5
Estimated H-index: 5
,
Peter Hajek44
Estimated H-index: 44
+ 1 AuthorsHayden McRobbie33
Estimated H-index: 33
Abstract To examine existing smoking studies that compare surgical patients who have recently quit smoking with those who continue to smoke to provide an evidence-based recommendation for front-line staff. Concerns have been expressed that stopping smoking within 8 weeks before surgery may be detrimental to postoperative outcomes. This has generated considerable uncertainty even in health care systems that consider smoking cessation advice in the hospital setting an important priority. Smokers w...
Published on Jul 1, 2009in Annals of Surgery9.48
John T. Mullen29
Estimated H-index: 29
,
Donald W. Moorman11
Estimated H-index: 11
,
Daniel L. Davenport30
Estimated H-index: 30
Objective:We sought to examine the effect of body mass index (BMI) on 30-day morbidity and mortality in a large cohort of patients undergoing nonbariatric general surgery.Summary Background Data:Obesity has long been considered a risk factor for poor outcomes from a variety of surgical procedures, y
Cited By3
Newest
Published on May 25, 2019in Public Health Ethics1.31
Rebecca C. H. Brown4
Estimated H-index: 4
(University of Oxford),
Hannah Maslen9
Estimated H-index: 9
(University of Oxford),
Julian Savulescu45
Estimated H-index: 45
(University of Oxford)
Published on Jun 24, 2019in Public Health Ethics1.31
Gloria Traina (University of Oslo), Pål E. Martinussen8
Estimated H-index: 8
(NTNU: Norwegian University of Science and Technology),
Eli Feiring4
Estimated H-index: 4
(University of Oslo)
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