Proposal of a score to detect the need for postoperative intensive care unit admission after bariatric surgery

Abstract

Background: We developed a multi-dimensional score which may help in predicting those patients, undergoing bariatric surgery, who may be in need for postoperative ICU admission and which may also help in avoiding unnecessary admission to the critical care units after bariatric surgery. Methods: We collected the data of 111patients who underwent either laparoscopic gastric sleeve or bypass and studied the association between some risk factors related to obesity and their postoperative ICU admission. Those factors found to be statistically significant are included in the final score. The cutoff value of our scoring system is determined by running a Receiver Operating Curve (ROC) analysis. Results: Forty patients (36%) were admitted to the ICU postoperatively. Our final score includes 7 independent variables; 6 found to be significantly related to post-bariatric surgery ICU admission; these are age, gender, BMI, ASA, obstructive sleep apnea and spirometry results, and the seventh is the history of venous thrombo-embolism. According to the ROC curve analysis, we set the score value of 10 as our cut-off value for the need of postoperative ICU admission. The score median value is 9. Males' odds to be admitted to the ICU after bariatric surgery are 11.9 times higher than females. Also, those with BMI above 50 kg m À2 have odds of 29.8 times higher than those below 50 kg m À2 . Conclusions: We propose a scoring system for risk stratification, in which some of the well-known predictor risk factors are included in a simple way to help identify those high-risk patients undergoing bariatric surgery.Conclusions: Trial registry number: NCT02976649.

General Anesthetic Care of Obese Patients Undergoing Surgery: A Review of Current Anesthetic Considerations and Recent Advances

“…Additionally, those that were admitted to the ICU were older, and more likely to be male with the strongest preoperative factors associated being diabetes mellitus, chronic respiratory disease, and obstructive apnea [ 64 ]. An additional study by Nofal et al proposes a scoring system to stratify risk for postoperative ICU admission in obese patients undergoing bariatric surgery [ 65 ]. The score includes the following factors significantly related to ICU admission: older age, male gender, higher BMI, higher ASA, OSA, and spirometry results [ 65 ].…”

“…An additional study by Nofal et al proposes a scoring system to stratify risk for postoperative ICU admission in obese patients undergoing bariatric surgery [ 65 ]. The score includes the following factors significantly related to ICU admission: older age, male gender, higher BMI, higher ASA, OSA, and spirometry results [ 65 ]. Therefore, due to the unplanned nature of ICU admission in obese patients due to the presence of comorbidities, we recommend they be stratified for potential ICU admission as part of preparation.…”