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Safety of Continuous Postoperative Pulse Oximetry Monitoring Without Obstructive Sleep Apnea Screening in > 5000 Patients Undergoing Bariatric Surgery

  • Sophie L. van VeldhuisenEmail author
  • Ibrahim Arslan
  • Laura N. Deden
  • Edo O. Aarts
  • Eric J. Hazebroek
Original Contributions
  • 42 Downloads

Abstract

Introduction

Obstructive sleep apnea (OSA) is common but often undiagnosed in obese patients undergoing bariatric surgery, and is associated with increased risk of cardiopulmonary complications. The aim of this study is to evaluate the safety of continuous postoperative pulse oximetry (CPOX) without preoperative OSA screening in bariatric patients.

Methods

Retrospective, single-center cohort study of all consecutive patients who underwent bariatric surgery between 2011 and 2017. All patients were postoperatively monitored with CPOX and received oxygen supplementation. Patients with no history of OSA (the “CPOX” only group) were compared with patients with adequately treated OSA as a reference group. The primary outcome was the incidence of cardiopulmonary complications within 30 days after surgery. Secondary outcomes included overall 30-day complications, mortality, intensive care unit (ICU) admissions, readmissions, and length of stay.

Results

In total, 5682 patients were included, 89.6% (n = 5089) had no history of OSA, 10.4% (n = 593) had adequately treated OSA. Cardiopulmonary complications occurred in the CPOX group and OSA group in 0.6% (n = 31) and 0.8% (n = 5), respectively (p = 0.171). No mortality occurred due to cardiopulmonary complications. In both groups, one patient required ICU admission for respiratory failure (p = 0.198). Non-cardiopulmonary complications occurred in 6.4% in the CPOX group and 7.8% in the OSA group (p = 0.792). Mortality, ICU admissions, readmissions, and length of stay were not significantly different between groups.

Conclusions

These data suggest that CPOX monitoring without preoperative OSA screening is a safe and effective strategy in perioperative care of bariatric patients. Future studies are needed to assess whether this strategy is also cost-effective.

Keywords

Morbid obesity Bariatric surgery Obstructive sleep apnea Continuous pulse oximetry Perioperative care 

Notes

Compliance with Ethical Standards

The protocol of this retrospective study was reviewed and approved by the Medical Ethics Committee of Rijnstate Hospital Arnhem.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11695_2019_4297_MOESM1_ESM.docx (17 kb)
Supplementary Table 1 (DOCX 17 kb)

References

  1. 1.
    Tishler PV, Larkin EK, Schluchter MD, et al. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA. 2003;289(17):2230–7.CrossRefGoogle Scholar
  2. 2.
    van Kralingen KW, de Kanter W, de Groot GH, et al. Assessment of sleep complaints and sleep-disordered breathing in a consecutive series of obese patients. Respiration. 1999;66(4):312–6.CrossRefGoogle Scholar
  3. 3.
    Peromaa-Haavisto P, Tuomilehto H, Kossi J, et al. Prevalence of obstructive sleep Apnoea among patients admitted for bariatric surgery. A Prospective Multicentre Trial Obes Surg. 2016;26(7):1384–90.PubMedGoogle Scholar
  4. 4.
    Lee YH, Johan A, Wong KK, et al. Prevalence and risk factors for obstructive sleep apnea in a multiethnic population of patients presenting for bariatric surgery in Singapore. Sleep Med. 2009;10(2):226–32.CrossRefGoogle Scholar
  5. 5.
    de Raaff CA, Pierik AS, Coblijn UK, et al. Value of routine polysomnography in bariatric surgery. Surg Endosc. 2017;31(1):245–8.CrossRefGoogle Scholar
  6. 6.
    Daltro C, Gregorio PB, Alves E, et al. Prevalence and severity of sleep apnea in a group of morbidly obese patients. Obes Surg. 2007;17(6):809–14.CrossRefGoogle Scholar
  7. 7.
    Dempsey JA, Veasey SC, Morgan BJ, et al. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47–112.CrossRefGoogle Scholar
  8. 8.
    Kaw R, Michota F, Jaffer A, et al. Unrecognized sleep apnea in the surgical patient: implications for the perioperative setting. Chest. 2006;129(1):198–205.CrossRefGoogle Scholar
  9. 9.
    Gali B, Whalen FX, Schroeder DR, et al. Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment. Anesthesiology. 2009;110(4):869–77.CrossRefGoogle Scholar
  10. 10.
    Macintyre PE, Loadsman JA, Scott DA. Opioids, ventilation and acute pain management. Anaesth Intensive Care. 2011;39(4):545–58.CrossRefGoogle Scholar
  11. 11.
    Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, Endoluminal, and Revisional procedures. Obes Surg. 2018;28(12):3783–94.CrossRefGoogle Scholar
  12. 12.
    de Raaff CAL, Gorter-Stam MAW, de Vries N, et al. Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline. Surg Obes Relat Dis. 2017;13(7):1095–109.CrossRefGoogle Scholar
  13. 13.
    Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth. 2010;57(5):423–38.CrossRefGoogle Scholar
  14. 14.
    Dogan K, Kraaij L, Aarts EO, et al. Fast-track bariatric surgery improves perioperative care and logistics compared to conventional care. Obes Surg. 2015;25(1):28–35.CrossRefGoogle Scholar
  15. 15.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefGoogle Scholar
  16. 16.
    Birkmeyer NJ, Dimick JB, Share D, et al. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304(4):435–42.CrossRefGoogle Scholar
  17. 17.
    Weller WE, Rosati C. Comparing outcomes of laparoscopic versus open bariatric surgery. Ann Surg. 2008;248(1):10–5.CrossRefGoogle Scholar
  18. 18.
    Mokhlesi B, Hovda MD, Vekhter B, et al. Sleep-disordered breathing and postoperative outcomes after bariatric surgery: analysis of the nationwide inpatient sample. Obes Surg. 2013;23(11):1842–51.CrossRefGoogle Scholar
  19. 19.
    Weingarten TN, Flores AS, McKenzie JA, et al. Obstructive sleep apnoea and perioperative complications in bariatric patients. Br J Anaesth. 2011;106(1):131–9.CrossRefGoogle Scholar
  20. 20.
    Huerta S, DeShields S, Shpiner R, et al. Safety and efficacy of postoperative continuous positive airway pressure to prevent pulmonary complications after Rouxen-Y gastric bypass. J Gastrointest Surg. 2002;6(3):354–8.CrossRefGoogle Scholar
  21. 21.
    Jensen C, Tejirian T, Lewis C, et al. Postoperative CPAP and BiPAP use can be safely omitted after laparoscopic roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4(4):512–4.CrossRefGoogle Scholar
  22. 22.
    El Shobary H, Backman S, Christou N, et al. Use of critical care resources after laparoscopic gastric bypass: effect on respiratory complications. Surg Obes Relat Dis. 2008;4(6):698–702.CrossRefGoogle Scholar
  23. 23.
    Malczak P, Pisarska M, Piotr M, et al. Enhanced recovery after bariatric surgery: systematic review and meta-analysis. Obes Surg. 2017;27(1):226–35.CrossRefGoogle Scholar
  24. 24.
    Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189–98.CrossRefGoogle Scholar
  25. 25.
    Morgan DJ, Ho KM, Armstrong J, et al. Incidence and risk factors for intensive care unit admission after bariatric surgery: a multicentre population-based cohort study. Br J Anaesth. 2015;115(6):873–82.CrossRefGoogle Scholar
  26. 26.
    Froylich D, Corcelles R, Davis M, et al. Factors associated with length of stay in intensive care after bariatric surgery. Surg Obes Relat Dis. 2016;12(7):1391–6.CrossRefGoogle Scholar
  27. 27.
    Lam T, Nagappa M, Wong J, et al. Continuous Pulse Oximetry and capnography Monitoring for postoperative respiratory depression and adverse events: a systematic review and meta-analysis. Anesth Analg. 2017;125(6):2019–29.CrossRefGoogle Scholar
  28. 28.
    Gallagher SF, Haines KL, Osterlund LG, et al. Postoperative hypoxemia: common, undetected, and unsuspected after bariatric surgery. J Surg Res. 2010;159(2):622–6.CrossRefGoogle Scholar
  29. 29.
    Ahmad S, Nagle A, McCarthy RJ, et al. Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg. 2008;107(1):138–43.CrossRefGoogle Scholar
  30. 30.
    Nepomnayshy D, Hesham W, Erickson B, et al. Sleep apnea: is routine preoperative screening necessary? Obes Surg. 2013;23(3):287–91.CrossRefGoogle Scholar
  31. 31.
    Kaw R, Chung F, Pasupuleti V, et al. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012;109(6):897–906.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Bariatric SurgeryRijnstate HospitalArnhemThe Netherlands
  2. 2.Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands

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