Hercules. Alphamaxx. Cmax. Operon D 850. Just as patients are getting bigger, so, too, are the names of some of today's surgical tables. They scream super heavyweight, sturdy and strong. Rest easy, they say: We're built to hold patients that are a lot bigger than they used to be.

Gone are the days when you had to strap two tables together for overweight and obese patients (remember, older tables are usually rated only for 400 pounds or less). Here's advice on upgrading tables to those designed to accommodate larger patients.

What a table can really lift
Before I moved into equipment planning about five years ago, I was director of surgical services for a two-hospital campus. I also did work for a couple of surgery centers. All told, I worked in the OR for 30 years. I can tell you that weight capacity was never our biggest concern when buying tables. It was a distant third behind versatility and durability.

All that changed one Saturday morning. I was in the hospital doing some paperwork when I received a panicked call from a nurse in the OR. A fairly large patient undergoing a neurology procedure was down at one end of the table and they couldn't get the table up in the air. I wound up on the floor, under the table, on the phone with a service tech. We all learned a very important lesson that day: Some capacity ratings are based on supine positioning only. There's a difference in how much weight the table will hold when the patient is static versus the amount of weight the table will hold when the table is in some type of articulated position. For example, if 1,200 pounds is a table's maximum load, it might drop to 1,000 pounds of lift capacity when you articulate the table for orthopedic cases or other procedures that have such strenuous positioning requirements as beach chair and Trendelenburg. This is a safety issue for both your patient and your staff. Ask your vendor about how much weight the table can support.

You want a table that can articulate heavyweight patients yet maintain necessary height. The ability to have the table lower to the ground gives the surgeon more accessibility to the patient. Here are other points to consider:

• Power option. The average overweight or obese person who meets criteria for outpatient surgery will probably be fine with a table rated for at least 500 pounds. Regardless of the high-end capacity, look for a table with a power option; asking your staff to manually push even 300 pounds presents an injury risk.
• Imaging. Many new tables let you rotate and slide the table tops. For ease of use, look at portable C-arms for maximum body imaging.
• Versatility. In addition to weight capacity, choose a table that gives you the most versatility for your money and can be used by many surgical specialties. Look for a surgical table that is easy to clean, move and maintain.
• Service. Is the table's vendor readily available for service?
• Trials. Involve physicians from different specialties in trials. Include anesthesia providers since they often manage OR table controls.
• Construction. How much of the table top is radiolucent? Review the mattress for composition, fire safety, ease of cleaning and general comfort. The increased size of patients can create pressure areas during extended procedures. Make sure the table's padding is thicker to help prevent pressure sores and nerve injuries. Also, is there a rechargeable battery available for the table?
• Ease of use of the table. Is patient positioning easily accomplished with minimal staff effort?

• Accessories and attachments. These are available from both the table manufacturer and other manufacturers. Be sure such add-ons as accessories for shoulder surgery and stirrups will hold heavier weights. Such basic accessories as arm boards and patient security straps should be included as part of the total cost of the OR table. General attachments include gel or foam pads, clamps, anesthesia screens, foot boards and table extenders. You'll also want to consider accessories for gyn (stirrups), orthopedics, spine and imaging extensions. Staff and physicians should trial this type of equipment. How easy is it to assemble and attach these to the table? If the accessories are from a manufacturer other than the table manufacturer, be sure the items are compatible with the table.
• Price. Expect to pay 20 percent more for a heavyweight table. One company's heavyweight table is $12,000 more than its regular capacity table.