Incidence and risk factors for intensive care unit admission after bariatric surgery: a multicentre population-based cohort study

Morgan, David; Ho, Kwok M.; Armstrong, J.; Baker, Stuart

doi:10.1093/bja/aev364

Cited by 40 publications

(20 citation statements)

References 29 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%

“…Thus, contrary to what was verified in the present study, both groups had different characteristics, and ICU stay was better justified. (16) A prospective Brazilian study with a sample of 120 patients submitted to laparoscopic bariatric surgery tested an index to evaluate the need for immediate hospitalization in intensive care, with no patients admitted to the ICU and no occurrence of postoperative complications. (14) …”

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%

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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%

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

View full text Add to dashboard Cite

show abstract

“…(2013*). ICU monitoring is recommended for those patients at high cardiopulmonary risk . Patients with left ventricular systolic dysfunction (left ventricular ejection fraction < 50%) had a slight excess in early postoperative heart failure and myocardial infarction but no excess mortality at 1 year .…”

Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

340

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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“…Based on this risk score, the mortality risk is low (0·3 per cent) with one variable, intermediate (1·9 per cent) with two or three variables and high (7·6 per cent) with four or five variables. Postoperative care in a monitored setting should be planned for high‐risk obese patients (older patients, BMI at least 50 kg/m 2 , moderate to severe OSAS, metabolic syndrome, obesity hypoventilation syndrome, other major co‐morbidities), especially after major, revisional or open surgery, or when parenteral opioids, or use of CPAP or NIPPV, is anticipated after operation.…”

Section: Resultsmentioning

confidence: 99%

Perioperative care of the obese patient

Carron

Fakhr

Ieppariello

et al. 2020

British Journal of Surgery

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Background Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in the foreseeable future, and should be prepared to provide optimal management for these individuals. This review provides an update of recent evidence regarding perioperative strategies for obese patients. Methods A search for papers on the perioperative care of obese patients (English language only) was performed in July 2019 using the PubMed, Scopus, Web of Science and Cochrane Library electronic databases. The review focused on the results of RCTs, although observational studies, meta‐analyses, reviews, guidelines and other reports discussing the perioperative care of obese patients were also considered. When data from obese patients were not available, relevant data from non‐obese populations were used. Results and conclusion Obese patients require comprehensive preoperative evaluation. Experienced medical teams, appropriate equipment and monitoring, careful anaesthetic management, and an adequate perioperative ventilation strategy may improve postoperative outcomes. Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery.

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Incidence and risk factors for intensive care unit admission after bariatric surgery: a multicentre population-based cohort study

Cited by 40 publications

References 29 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

Perioperative care of the obese patient

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