Obesity Surgery

, Volume 18, Issue 2, pp 171–178

High Mortality Rate for Patients Requiring Intensive Care After Surgical Revision Following Bariatric Surgery

  • Nathalie Kermarrec
  • Jean-Pierre Marmuse
  • Judith Faivre
  • Sigismond Lasocki
  • Philippe Mognol
  • Denis Chosidow
  • Claudette Muller
  • Jean-Marie Desmonts
  • Philippe Montravers
Research Article

Abstract

Background

To report the prognosis and management of patients reoperated for severe intraabdominal sepsis (IAS) after bariatric surgery (S0) and admitted to the surgical intensive care unit (ICU) for organ failure.

Methods

A French observational study in a 12-bed adult surgical intensive care unit in a 1,200-bed teaching hospital with expertise in bariatric surgery. From January 2001 to August 2006, 27 morbidly obese patients (18 transferred from other institutions) developed severe postoperative IAS (within 45 days). Clinical signs, biochemical and radiologic findings, and treatment during the postoperative course after S0 were reviewed. Time to reoperation, characteristics of IAS, demographic data, and disease severity scores at ICU admission were recorded and their influence on prognosis was analyzed.

Results

The presence of respiratory signs after S0 led to an incorrect diagnosis in more than 50% of the patients. Preoperative weight (body mass index [BMI] > 50 kg/m2) and multiple reoperations were associated with a poorer prognosis in the ICU. The ICU mortality rate was 33% and increased with the number of organ failures at reoperation.

Conclusion

During the initial postoperative course after bariatric surgery, physical examination of the abdomen is unreliable to identify surgical complications. The presence of respiratory signs should prompt abdominal investigations before the onset of organ failure. An urgent laparoscopy, as soon as abnormal clinical events are detected, is a valuable tool for early diagnosis and could shorten the delay in treatment.

Keywords

Bariatric surgery Obesity Postoperative peritonitis Sepsis Intensive care unit 

References

  1. 1.
    Olshansky SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005;352(11):1138–45.PubMedCrossRefGoogle Scholar
  2. 2.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351(26):2683–93.PubMedCrossRefGoogle Scholar
  3. 3.
    DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med 2007;356(21):2176–83.PubMedCrossRefGoogle Scholar
  4. 4.
    Fernandez AZ Jr, Demaria EJ, Tichansky DS, et al. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg 2004;239(5):698–702; discussion 702–3.PubMedCrossRefGoogle Scholar
  5. 5.
    Gonzalez R, Nelson LG, Gallagher SF, Murr MM. Anastomotic leaks after laparoscopic gastric bypass. Obes Surg 2004;14(10):1299–307.PubMedCrossRefGoogle Scholar
  6. 6.
    Hamilton EC, Sims TL, Hamilton TT, et al. Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 2003;17(5):679–84.PubMedCrossRefGoogle Scholar
  7. 7.
    Mognol P, Chosidow D, Marmuse JP. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding in the super-obese: a comparative study of 290 patients. Obes Surg 2005;15(1):76–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Montravers P, Gauzit R, Muller C, et al. Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy. Clin Infect Dis 1996;23(3):486–94.PubMedGoogle Scholar
  9. 9.
    Le Gall JR. The use of severity scores in the intensive care unit. Intensive Care Med 2005;31(12):1618–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 2003;31(4):1250–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Gonzalez R, Sarr MG, Smith CD, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg 2007;204(1):47–55.PubMedCrossRefGoogle Scholar
  12. 12.
    Fernandez AZ Jr, DeMaria EJ, Tichansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc 2004;18(2):193–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Goldfeder LB, Ren CJ, Gill JR. Fatal complications of bariatric surgery. Obes Surg 2006;16(8):1050–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Mehran A, Liberman M, Rosenthal R, Szomstein S. Ruptured appendicitis after laparoscopic Roux-enY gastric bypass: pitfalls in diagnosing a surgical abdomen in the morbidly obese. Obes Surg 2003;13(6):938–40.PubMedCrossRefGoogle Scholar
  15. 15.
    Merkle EM, Hallowell PT, Crouse C, et al. Roux-en-Y gastric bypass for clinically severe obesity: normal appearance and spectrum of complications at imaging. Radiology 2005;234(3):674–83.PubMedCrossRefGoogle Scholar
  16. 16.
    Madan AK, Stoecklein HH, Ternovits CA, et al. Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass. Surg Endosc 2007;21(2):194–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Bercault N, Boulain T, Kuteifan K, et al. Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med 2004;32(4):998–1003.PubMedCrossRefGoogle Scholar
  18. 18.
    Ray DE, Matchett SC, Baker K, et al. The effect of body mass index on patient outcomes in a medical ICU. Chest 2005;127(6):2125–31.PubMedCrossRefGoogle Scholar
  19. 19.
    Pasulka PS, Bistrian BR, Benotti PN, Blackburn GL. The risks of surgery in obese patients. Ann Intern Med 1986;104(4):540–6.PubMedGoogle Scholar
  20. 20.
    Nasraway SA Jr, Albert M, Donnelly AM, et al. Morbid obesity is an independent determinant of death among surgical critically ill patients. Crit Care Med 2006;34(4):964–70; quiz 971.PubMedCrossRefGoogle Scholar
  21. 21.
    Helling TS, Willoughby TL, Maxfield DM, Ryan P. Determinants of the need for intensive care and prolonged mechanical ventilation in patients undergoing bariatric surgery. Obes Surg 2004;14(8):1036–41.PubMedCrossRefGoogle Scholar
  22. 22.
    Cendan JC, Abu-aouf D, Gabrielli A, et al. Utilization of intensive care resources in bariatric surgery. Obes Surg 2005;15(9):1247–51.PubMedCrossRefGoogle Scholar
  23. 23.
    Bohnen J, Boulanger M, Meakins JL, McLean AP. Prognosis in generalized peritonitis. Relation to cause and risk factors. Arch Surg 1983;118(3):285–90.PubMedGoogle Scholar
  24. 24.
    Seiler CA, Brugger L, Forssmann U, et al. Conservative surgical treatment of diffuse peritonitis. Surgery 2000;127(2):178–84.PubMedCrossRefGoogle Scholar
  25. 25.
    Pitcher WD, Musher DM. Critical importance of early diagnosis and treatment of intra-abdominal infection. Arch Surg 1982;117(3):328–33.PubMedGoogle Scholar
  26. 26.
    Koperna T, Schulz F. Prognosis and treatment of peritonitis. Do we need new scoring systems? Arch Surg 1996;131(2):180–6.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Nathalie Kermarrec
    • 1
    • 4
  • Jean-Pierre Marmuse
    • 2
  • Judith Faivre
    • 1
  • Sigismond Lasocki
    • 1
  • Philippe Mognol
    • 2
  • Denis Chosidow
    • 2
  • Claudette Muller
    • 3
  • Jean-Marie Desmonts
    • 1
  • Philippe Montravers
    • 1
  1. 1.Department of Surgical Intensive Care Unit and AnesthesiologyHôpital Bichat Claude Bernard, Assistance Publique-Hôpitaux de ParisParisFrance
  2. 2.Department of General SurgeryHôpital Bichat Claude Bernard, Assistance Publique-Hôpitaux de ParisParisFrance
  3. 3.Microbiology LaboratoryHôpital Bichat Claude Bernard, Assistance Publique-Hôpitaux de ParisParisFrance
  4. 4.Service d’Anesthésie-Réanimation ChirurgicaleHôpital Bichat Claude Bernard, Assistance Publique-Hôpitaux de ParisParisFrance

Personalised recommendations