Characteristics and Outcome of Patients Admitted to the ICU Following Bariatric Surgery

Broek, Renee van den; Buise, Marc P.; Dielen, François Mh van; Bindels, Alexander J. G. H.; Zundert, André van; Smulders, J. F.

doi:10.1007/s11695-008-9699-0

Cited by 25 publications

(7 citation statements)

References 23 publications

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“…(12,13,16,17) Research involving 12,062 patients undergoing bariatric surgeries, of whom only 590 (4.90%) were admitted to the ICU postoperatively, showed that this group of patients had a significantly higher mean age and more frequently required an abdominal reoperation. Thus, contrary to what was verified in the present study, both groups had different characteristics, and ICU stay was better justified.…”

Section: Discussionmentioning

confidence: 99%

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Immediate postoperative of bariatric surgery in the intensive care unit versus an inpatient unit. A retrospective study with 828 patients

Penna¹,

Vaz²,

Fonseca³

et al. 2017

Revista Brasileira De Terapia Intensiva

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ObjectiveTo compare the incidence of complications and the duration of hospitalization of patients undergoing bariatric surgery admitted to the intensive care unit or a post-surgical hospitalization unit.MethodsThis retrospective observational study included 828 patients admitted between January 2010 and February 2015 during the immediate postoperative period of bariatric surgery in a hospital. Data were collected via electronic medical records. The Mann-Whitney test was used to compare continuous variables, and the chi-square was used to compare categorical variables.ResultsPatients in both groups had similar demographic characteristics, with no significant differences in anthropometric data and comorbidities. There was no significant difference in the comparison of complications between the two groups. However, the group admitted to the intensive care unit had longer hospitalization times (median of 3 days versus 2 days, p < 0.05), and hospital costs were 8% higher.ConclusionThe present study found no benefit in the routine admittance of patients to the intensive care unit after undergoing bariatric surgery. This practice increased hospitalization time and hospital costs, which wasted resources. It is necessary to create objective criteria to identify patients requiring intensive care unit admission after bariatric surgery.

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Section: Discussionmentioning

confidence: 99%

“…(12-15) However, international studies show the current preference for avoiding routine ICU hospitalization, which reduces the mean hospital stay, reduces costs and releases beds, which are increasingly scarce, for other patients. (8,16,17) …”

Section: Introductionmentioning

confidence: 99%

Immediate postoperative of bariatric surgery in the intensive care unit versus an inpatient unit. A retrospective study with 828 patients

Penna¹,

Vaz²,

Fonseca³

et al. 2017

Revista Brasileira De Terapia Intensiva

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“…Also, OSA is related to severe respiratory complications and ICU admission. Reducing costs by identifying and treating risk patients with CPAP and consequently avoiding the expensive use of ICU facilities is desirable [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

STOP-Bang and the effect on patient outcome and length of hospital stay when patients are not using continuous positive airway pressure

et al. 2014

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BackgroundIn patients undergoing surgical interventions under general anesthesia, obstructive sleep apnea syndrome (OSA) can cause serious perioperative cardiovascular or respiratory complications leading to fatal consequences, even sudden death. In this study we test the hypothesis that morbidly obese patients diagnosed by a polysomnography test and using continuous positive airway pressure (CPAP) therapy have fewer and less severe perioperative complications and a shorter hospital stay than patients who have a medical history that meets at least three STOP-Bang criteria and are not using CPAP therapy.MethodsPostoperative hospital stay and pulmonary complications were analyzed in three groups of morbidly obese patients undergoing bariatric surgery (Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy) between January 2009 and November 2013 (n = 693). Group A comprised 99 patients who were preoperatively diagnosed with OSA based on polysomnography results. These patients used CPAP therapy before and after surgery. Group B consisted of 182 patients who met at least three STOP-Bang criteria but who were not diagnosed with OSA based on polysomnography results. These patients did not use CPAP. Group C, the reference group, comprised 412 patients who scored one to two items on the STOP-Bang.ResultsDuring the perioperative period, Group B patients had a significantly (p < 0.001) higher cumulative rate of pulmonary complications, worse oxygen saturation, respiratory rates, and increased length of stay in hospital. There was also two cases of sudden death in this group.ConclusionBased on these results, we conclude that patients meeting at least three STOP-BANG criteria have higher postoperative complications and an increased length of hospital stay than patients using CPAP.

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“…Consequently, preoperative cardiac risk assessment is extremely important, including liberal use of stress echocardiography (82) (because myocardial perfusion imaging requires special tables and apertures that may not accommodate the obese patient). Patients with obesity are emergently admitted to the ICU more commonly than patients without obesity and more commonly for a cardiac-related complication (83). Unfortunately, identifying a cardiac etiology for readmission may go undiagnosed initially (83,84).…”

Section: Postoperative Cardiac Complicationsmentioning

confidence: 99%

“…Patients with obesity are emergently admitted to the ICU more commonly than patients without obesity and more commonly for a cardiac-related complication (83). Unfortunately, identifying a cardiac etiology for readmission may go undiagnosed initially (83,84). In addition, patients with morbid obesity have severely limited cardiorespiratory fitness that is similar to those patients with established severe systolic heart dysfunction (85,86).…”

Section: Postoperative Cardiac Complicationsmentioning

confidence: 99%

Difficulties in managing the surgical patient who is morbidly obese

King

Velmahos

2010

Critical Care Medicine

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Managing patients who are morbidly obese in the intensive care unit is associated with a variety of problems uncommonly experienced with the those who are not morbidly obese. Clinicians experience a myriad of unique problems and circumstances, from the need for special beds and lifts to unusual and unknown volumes of distribution resulting in unclear drug dosing. This review examines several issues including sedation, invasive monitoring, venous thromboembolism prophylaxis, surgical infections, nutritional support, and other complications that may be of particular importance to the critically ill patient who is morbidly obese. In many cases, care is altered based on the complicating issues surrounding morbid obesity. In other cases, the presence of obesity suggests no alterations in our routine critical care delivery. A comprehensive review of the literature is undertaken, data are critically considered, and overall opinion is rendered based on the available peer-reviewed literature. In many cases, data are not available that address the specific patient population in question, so related papers (like gastric bypass data) are considered. Many issues do not have definitive answers based on randomized controlled trials, and much is left to treating clinician opinion and local practice patterns. Where good data exist, however, one should consider carefully and individually deviation from the evidence-based approach.

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Characteristics and Outcome of Patients Admitted to the ICU Following Bariatric Surgery

Abstract: The ICU admission rate in our report is 8%. This study showed that 32 ICU days are needed per 100 diverse bariatric procedures. Most patients are admitted to the ICU for only a few days and the majority of the admissions is planned.

Cited by 25 publications

References 23 publications

Immediate postoperative of bariatric surgery in the intensive care unit versus an inpatient unit. A retrospective study with 828 patients

Immediate postoperative of bariatric surgery in the intensive care unit versus an inpatient unit. A retrospective study with 828 patients

STOP-Bang and the effect on patient outcome and length of hospital stay when patients are not using continuous positive airway pressure

Difficulties in managing the surgical patient who is morbidly obese

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