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to the lungs. patients have body mass index less than 23, really, really skinny people out there are high risk at death after surgery within the the first 30 days after surgery by 40%. jamie: what happens? it s harder to operate on a person that has fat, isn t it. that s true. i think hypothesis, they may be malnourished. some of the the patients have can and may be immuno compromised and risk factor such as diabetes. most are these are colorectal or abdominal surgery and as much as they minimize the amount surgery, there s he trauma to the body and some malnourished some of the patients that are really like low he weight, you have to be careful. what s the message to the doctors? i think the art of medicine is not to operate on everyone, it s to really select your patients very carefully.