Considerable controversy exists about the perioperative management of patients at high risk for obstructive sleep apnea (OSA) in free-standing clinics. Eighty-eight percent of an American Society of Anesthesiologists expert panel felt that upper abdominal laparoscopic surgery could not be performed safely on an outpatient basis. We sought to review the incidence of major adverse events after outpatient laparoscopic adjustable gastric banding (LAGB) in a high risk population for OSA at a free-standing facility. Research Ethics Board approval was obtained and charts were reviewed retrospectively for 2,370 LAGB performed at a free-standing clinic between 2005 and 2009. In this observational cohort study, patients were classified as high risk for OSA if they received continuous positive airway pressure (CPAP) treatment for OSA pre-operatively or had a history of at least three STOP-BANG criteria. Follow-up was verified and adverse events reviewed, including death, unanticipated transfer or admission to hospital within 30 days. A total of 746 of the 2,370 patients (31%) met criteria for or were at high risk for OSA (357 received CPAP for OSA and 389 by STOP-BANG criteria). The incidence of transient desaturation to less than 93% was 39.5%. There were no deaths and no cases of respiratory failure or re-intubation. The 30-day mortality was zero and the 30-day anesthesia related morbidity was less than 0.5%. For patients at high risk for OSA after LAGB, the significance of transient oxygen desaturation and the need to develop monitoring and admission standards remain to be determined.
Sleep apnea Obstructive Ambulatory care facilities Obesity
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We acknowledge the assistance of the following individuals during data collection, analysis, and document preparation: Dr. Bob Babak and Mrs. Rubina Jan.
Dr. Cobourn is a consultant with Allergan and has received an unrestricted research grant and speaking honoraria. The authors declare that they have no conflict of interest.
Young T, Hutton R, Finn L, et al. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med. 1996;156(21):2445–51.PubMedCrossRefGoogle Scholar
Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071–8.PubMedGoogle Scholar
Liao P, Yegneswaran B, Vairavanathan S, et al. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anaesth. 2009;56(11):819–28. Reviewer#3 comment#15.PubMedCrossRefGoogle Scholar
The American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea. Anesthesiology. 2006;104(5):1081–93.CrossRefGoogle Scholar
Bergland A, Gislason H, Raeder J. Fast-track surgery for bariatric laparoscopic gastric bypass with focus on anaesthesia and peri-operative care. Experience with 500 cases. Acta Anaesthesiol Scand. 2008;52(10):1394–9.PubMedCrossRefGoogle Scholar
McCarty TM, Arnold DT, Lamont JP, et al. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242(4):494–8.PubMedGoogle Scholar
Watkins BM, Montgomery KF, Ahroni JH, et al. Adjustable gastric banding in an ambulatory surgery center. Obes Surg. 2005;15(5):1045–9.PubMedCrossRefGoogle Scholar
Peiser J, Lavie P, Ovnat A, et al. Sleep apnea syndrome in the morbidly obese as an indication for weight reduction surgery. Ann Surg. 1984;199(1):112–5.PubMedCrossRefGoogle Scholar
Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth. 2010;57(5):423–38.PubMedCrossRefGoogle Scholar
Kurrek MM, Twersky RS. Office-based anesthesia: how to start an office-based practice. Anesthesiol Clin. 2010;28(2):353–67.PubMedCrossRefGoogle Scholar