Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline

Raaff, Christel A.L. de; Gorter-Stam, Marguerite; Vries, Nico de; Sinha, Ashish; Bonjer, H. Jaap; Chung, Frances; Coblijn, Usha K.; Dahan, Albert; Helder, Rick S. van den; Hilgevoord, A.A.J.; Hillman, David R.; Margarson, M.; Mattar, Samer G.; Mulier, J. P.; Ravesloot, Madeline J. L.; Reiber, Beata M. M.; Rijswijk, Anne Sophie van; Singh, Preet Mohinder; Steenhuis, Roos; Tenhagen, Mark; Vanderveken, Olivier M.; Verbraecken, Johan; White, David P.; Wielen, Nicole van der; Wagensveld, Bart A. van

doi:10.1016/j.soard.2017.03.022

Cited by 123 publications

(94 citation statements)

References 145 publications

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“…The use of CPAP immediately after bariatric surgery is not associated with increased risk of anastomotic or suture‐line leaks . According to guidelines, patients with OSA who have had bariatric surgery should have continuous monitoring with pulse oximetry in the early postoperative period with minimization of sedatives and opioids . Since patients with OSA and adequate CPAP use are at low risk for cardiopulmonary complications after laparoscopic bariatric surgery, routine ICU admission in the immediate postoperative period is not necessary .…”

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

339

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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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

339

464

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“…Previous OSA-related practice guidelines 8 – 12 have been published by the American Society of Anesthesiologists, 8 , 9 the Society for Ambulatory Anesthesia, 10 the American Academy of Sleep Medicine, 11 the SASM, 7 the International Bariatric Consensus Guideline Group, 13 and the task force on best practice recommendations for the anesthetic perioperative care and pain management in weight loss surgery. 14 …”

Section: What Other Guidelines and Reviews Are Available?mentioning

confidence: 99%

Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea

Memtsoudis

Cozowicz

Nagappa

et al. 2018

Anesthesia &Amp; Analgesia

Self Cite

146

158

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The purpose of the Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea (OSA) is to present recommendations based on current scientific evidence. This guideline seeks to address questions regarding the intraoperative care of patients with OSA, including airway management, anesthetic drug and agent effects, and choice of anesthesia type. Given the paucity of high-quality studies with regard to study design and execution in this perioperative field, recommendations were to a large part developed by subject-matter experts through consensus processes, taking into account the current scientific knowledge base and quality of evidence. This guideline may not be suitable for all clinical settings and patients and is not intended to define standards of care or absolute requirements for patient care; thus, assessment of appropriateness should be made on an individualized basis. Adherence to this guideline cannot guarantee successful outcomes, but recommendations should rather aid health care professionals and institutions to formulate plans and develop protocols for the improvement of the perioperative care of patients with OSA, considering patient-related factors, interventions, and resource availability. Given the groundwork of a comprehensive systematic literature review, these recommendations reflect the current state of knowledge and its interpretation by a group of experts at the time of publication. While periodic reevaluations of literature are needed, novel scientific evidence between updates should be taken into account. Deviations in practice from the guideline may be justifiable and should not be interpreted as a basis for claims of negligence.

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“…Recent recommendations include the use of the STOP-Bang score in conjunction with saturation monitoring as screening tool for OSA, and we are adjusting accordingly. 20 Due to the low volume of metabolic procedures at our centre, and the often overloaded and understaffed surgical wards, patients were treated in a high-care or ICU for the first 24 hours postoperatively. The demand for high care beds in an academic centre, coupled with the fact that apnoea monitoring and early mobilization form the cornerstone of immediate postoperative care in patients undergoing MS, will lead to innovative postoperative care strategies over time, helping to formulate future guidelines.…”

Section: Discussionmentioning

confidence: 99%

Metabolic surgery in South Africa: an initial academic hospital experience

et al. 2019

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Background: In South Africa, 42.0% of adult females and 13.5% of adult males are classified as obese, the highest recorded numbers in Sub-Saharan Africa. Metabolic surgery has been proven to be a safe and effective treatment, yet due to demand on government resources has only been performed to a limited extent in public hospitals. The aim of this study was to describe the safety and efficacy of performing metabolic surgery at a single academic hospital in South Africa. Methods: This was a single centre retrospective review of 57 metabolic surgery procedures performed from October 2011 to September 2017 at Tygerberg Hospital, Cape Town, South Africa. The primary outcome was safety including mortality and adverse events. Secondary outcomes included effect of surgery on weight and diabetes resolution. Results: A total of 57 patients underwent laparoscopic metabolic surgery, of which 44 (83.0%) were female with a mean age (standard deviation) of 42.8 (8.0) years. Fifty-six patients (98%) underwent Roux-and-Y gastric bypass and one (2%) had a sleeve gastrectomy performed. There were no mortalities and overall morbidity was 14.0%, with 3 (5.3%) classified as major and 5 (8.8%) as minor. The follow-up rate at 1 year was 100%. Mean preoperative body mass index (BMI) was 58.8 kg/m2, and comorbidities included hypertension (59.6%), Type 2 Diabetes (42.1%), and dyslipidaemia (36.8%). There were no conversions to open surgery and at one year the mean (95% confidence interval) percentage excess body mass index loss was 50.4% (44.0-56.8%). Conclusions: Metabolic surgery can be performed safely in the public sector in South Africa, with short-term safety and efficacy outcomes comparable to international reports. Larger scale studies are needed to determine long-term outcomes and cost-effectiveness.

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Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline

Cited by 123 publications

References 145 publications

Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea

Metabolic surgery in South Africa: an initial academic hospital experience

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