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Preoperative factors predictive of complicated postoperative management after Roux-en-Y gastric bypass for morbid obesity

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Abstract

Introduction: This study was undertaken to determine preoperative predictive factors of complicated postoperative management after Roux-en-Y gastric bypass (RYGB) for morbid obesity.Methods: Between January 1999 and January 2002, 158 patients who underwent a RYGB received a standardized preoperative evaluation and data were collected prospectively. Complicated postoperative management was defined as patients requiring postoperative ICU admission for ≥48 h, or those needing transfer from the floor to the ICU. Patients with complicated management were compared with those in whom ICU admission was not necessary.Results: Twenty-three patients (14.5%) required prolonged ICU admission (mean stay of 6.3 ± 1.7 days). After multivariate analysis, body mass index (BMI) >50 kg/m2, forced expiratory volume (FEV1) <80% predicted, previous abdominal surgeries, and abnormal EKG were found to be independently associated with an increased likelihood of complicated postoperative care.Conclusion: BMI >50 kg/m2, FEV1 <80% predicted, previous abdominal surgeries, and abnormal EKG increase the likelihood of complicated postoperative management after RYGB for morbid obesity.

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References

  1. MA Alpert BE Terry MV Cohen TM Fan JA Painter CV Massey (2000) ArticleTitleThe electrocardiogram in morbid obesity. Am J Cardiol 85 908–910 Occurrence Handle10.1016/S0002-9149(99)00894-2 Occurrence Handle1:STN:280:DC%2BD3c3itVKnsw%3D%3D Occurrence Handle10758940

    Article  CAS  PubMed  Google Scholar 

  2. MA Alpert BE Terry CR Hamm TM Fan MV Cohen CV Massey JA Painter (2001) ArticleTitleEffect of weight loss on the ECG of normotensive morbidly obese patients. Chest 119 507–510 Occurrence Handle10.1378/chest.119.2.507 Occurrence Handle1:STN:280:DC%2BD3M7psVKlsA%3D%3D Occurrence Handle11171730

    Article  CAS  PubMed  Google Scholar 

  3. S Benoist Y Panis A Alves P Valleur (2000) ArticleTitleImpact of obesity on surgical outcomes after colorectal resection. Am J Surg 179 275–281 Occurrence Handle10.1016/S0002-9610(00)00337-8 Occurrence Handle1:STN:280:DC%2BD3czjs1eqtA%3D%3D Occurrence Handle10875985

    Article  CAS  PubMed  Google Scholar 

  4. EL Blouw AD Rudolph BJ Narr MG Sarr (2003) ArticleTitleThe frequency of respiratory failure in patients with morbid obesity undergoing gastric bypass. AANA J 71 45–50 Occurrence Handle12776650

    PubMed  Google Scholar 

  5. JA Brooks-Bunn (1997) ArticleTitlePredictors of postoperative complications following abdominal surgery. Chest 111 564–571 Occurrence Handle9118688

    PubMed  Google Scholar 

  6. PS Choban L Flanchaum (1997) ArticleTitleThe impact of obesity on surgical outcomes: a review. J Am Coll Surg 185 593–603 Occurrence Handle10.1016/S1072-7515(97)00109-9 Occurrence Handle1:STN:280:DyaK1c%2Fmsleqsg%3D%3D Occurrence Handle9404886

    Article  CAS  PubMed  Google Scholar 

  7. D De Bacquer De Backer G M Kornitzer (2000) ArticleTitlePrevalences of ECG findings in large population based samples of men and women. Heart 84 625–633 Occurrence Handle10.1136/heart.84.6.625 Occurrence Handle1:STN:280:DC%2BD3M%2FksFCjsg%3D%3D Occurrence Handle11083741

    Article  CAS  PubMed  Google Scholar 

  8. EJ DeMaria HJ Sugerman JM Kellum JG Meador LG Wolfe (2002) ArticleTitleResults of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 235 640–647 Occurrence Handle11981209

    PubMed  Google Scholar 

  9. MI Dunn BS Lipman (1989) Cardiac arrhythmias, parts II-V. MI Dunn BS Lipman (Eds) Clinical electrocardiography, 8th ed, Year Book Medical Chicago 345–443

    Google Scholar 

  10. A El-Solh P Sikka E Bozkanat W Jaafar J Davies (2001) ArticleTitleMorbid obesity in the medical ICU. Chest 120 1989–1997 Occurrence Handle10.1378/chest.120.6.1989 Occurrence Handle1:STN:280:DC%2BD3MnpsVyrsw%3D%3D Occurrence Handle11742933

    Article  CAS  PubMed  Google Scholar 

  11. A El-Gamal D Gallagher A Nawras P Gandhi J Gomez DV Allison JS Steinberg D Shumacher R Blank SB Heymsfield (1995) ArticleTitleEffects of obesity on QT, RR, and QTc intervals. Am J Cardiol 75 956–959 Occurrence Handle10.1016/S0002-9149(99)80700-0 Occurrence Handle1:STN:280:ByqB2M%2FmvVY%3D Occurrence Handle7733014

    Article  CAS  PubMed  Google Scholar 

  12. JC Hall RA Tarala JL Hall J Mander (1991) ArticleTitleA multivariate analysis of the risk of pulmonary complications after laparotomy. Chest 99 923–927 Occurrence Handle1:STN:280:By6C1czptFc%3D Occurrence Handle2009796

    CAS  PubMed  Google Scholar 

  13. EW Hancock (1997) ArticleTitleObesity and an abnormal ECG. Hosp Pract 15 19–20

    Google Scholar 

  14. G Hendenstierna A Strandberg B Brismar H Lundqvist L Svensson L Tokics (1985) ArticleTitleFunctional residual capacity, thoracoabdominal dimensions and central blood volume during general anesthesia and muscle paralysis and mechanical ventilation. Anesthesiology 62 247–254 Occurrence Handle3977112

    PubMed  Google Scholar 

  15. EH Livingston S Huerta D Arthur S Lee S DeShields D Heber (2002) ArticleTitleMale gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg 236 576–582 Occurrence Handle10.1097/00000658-200211000-00007 Occurrence Handle12409663

    Article  PubMed  Google Scholar 

  16. EH Livingston CY Ko (2002) ArticleTitleAssessing the relative contribution of individual risk factors on surgical outcome for gastric bypass surgery: a baseline probability analysis. J Surg Res 105 48–52 Occurrence Handle10.1006/jsre.2002.6448 Occurrence Handle12069501

    Article  PubMed  Google Scholar 

  17. J Lopez J Sumg W Anderson J Stone S Gallagher D Shapiro A Rosemurgy MM Murr (2002) ArticleTitleIs bariatric surgery safe in academic centers?. Am Surg 68 820–823 Occurrence Handle12356158

    PubMed  Google Scholar 

  18. P Marik J Varon (1998) ArticleTitleThe obese patient in the ICU. Chest 113 492–498 Occurrence Handle1:STN:280:DyaK1c7ktVyisw%3D%3D Occurrence Handle9498970

    CAS  PubMed  Google Scholar 

  19. TD Myles J Gooch J Santolaya (2002) ArticleTitleObesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol 100 959–964

    Google Scholar 

  20. NT Nguyen C Goldman J Rosenquiest A Arango CJ Cole SJ Lee BM Wolfe (2001) ArticleTitleLaparoscopic versus open gastric bypass: A randomized study of outcomes, quality of life, and costs. Ann Surg 234 279–291 Occurrence Handle10.1097/00000658-200109000-00002 Occurrence Handle1:STN:280:DC%2BD3MvotVymtA%3D%3D Occurrence Handle11524581

    Article  CAS  PubMed  Google Scholar 

  21. NT Nguyen SL Lee C Goldman N Fleming A Arango R McFall BM Wolfe (2001) ArticleTitleComparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial. J Am Coll Surg 192 469–477 Occurrence Handle10.1016/S1072-7515(01)00822-5 Occurrence Handle1:STN:280:DC%2BD3M3ivFSktg%3D%3D Occurrence Handle11294404

    Article  CAS  PubMed  Google Scholar 

  22. P Pelosi I Ravagnan G Giurati M Panigada N Bottino S Tredici G Eccher L Gattinoni (1999) ArticleTitlePositive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 91 1221–1231 Occurrence Handle1:STN:280:DC%2BD3c%2FhslOgsA%3D%3D Occurrence Handle10551570

    CAS  PubMed  Google Scholar 

  23. AJ Pilarsky Y Saida T Yamaguchi S Martinez W Chen EG Weiss JJ Nogueras SD Wexner (2002) ArticleTitleIs obesity a high-risk factor for laparoscopic colorectal surgery?. Surg Endosc 16 855–858 Occurrence Handle10.1007/s004640080069 Occurrence Handle11997837

    Article  PubMed  Google Scholar 

  24. DK Rose MM Cohen DF Wigglesworth DP DeBoer (1994) ArticleTitleCritical respiratory events in the post anesthesia care unit. Patient, surgical, and anesthetic factors. Anesthesiology 81 410–418 Occurrence Handle1:STN:280:ByuA3s%2FmtF0%3D Occurrence Handle8053592

    CAS  PubMed  Google Scholar 

  25. PR Schauer S Ikramuddin W Gourash R Ramanathan J Luketich (2000) ArticleTitleOutcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232 515–529 Occurrence Handle10.1097/00000658-200010000-00007 Occurrence Handle1:STN:280:DC%2BD3M%2Fhs1eitA%3D%3D Occurrence Handle10998650

    Article  CAS  PubMed  Google Scholar 

  26. PR Schauer J Luna AA Ghaitas ME Glenn JM Warren KR Sirinek (1993) ArticleTitlePulmonary function after laparoscopic cholecystectomy. Surgery 114 389–397 Occurrence Handle8342140

    PubMed  Google Scholar 

  27. C See PL Carter D Elliott P Mullenix W Eggebroten C Porter D Watts (2002) ArticleTitleAn institutional experience with laparoscopic gastric bypass complications seen in the first year compared with open gastric bypass complications during the same period. Am J Surg 183 533–538 Occurrence Handle10.1016/S0002-9610(02)00829-2 Occurrence Handle12034387

    Article  PubMed  Google Scholar 

  28. W Schwenk B Bohm C Witt T Junghans K Grundel JM Muller (1999) ArticleTitlePulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation. Arch Surg 134 6–12 Occurrence Handle10.1001/archsurg.134.1.6 Occurrence Handle1:STN:280:DyaK1M7isVeisA%3D%3D Occurrence Handle9927122

    Article  CAS  PubMed  Google Scholar 

  29. Jr E Trayner BR Celli (2001) ArticleTitlePostoperative pulmonary complications. Med Clin North Am 85 1129–1139 Occurrence Handle11565490

    PubMed  Google Scholar 

  30. M Valencia-Flores A Orea VA Castano M Resendiz M Rosales V Rebollar V Santiago J Gallegos RM Campos J González J Oseguera G García-Ramos DL Bliwise (2000) ArticleTitlePrevalence of sleep apnea and electrocardiographic disturbances in morbidly obese patients. Obes Res 8 262–269 Occurrence Handle1:STN:280:DC%2BD3cvjtlyntQ%3D%3D Occurrence Handle10832770

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Emory Bariatrics and Endosurgery Unit, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322, USA

    R. Gonzalez, S. P. Bowers, K. R. Venkatesh, E. Lin & C. D. Smith

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  1. R. Gonzalez
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  2. S. P. Bowers
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  3. K. R. Venkatesh
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  4. E. Lin
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  5. C. D. Smith
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Correspondence to C. D. Smith.

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Gonzalez, R., Bowers, S., Venkatesh, K. et al. Preoperative factors predictive of complicated postoperative management after Roux-en-Y gastric bypass for morbid obesity . Surg Endosc 17, 1900–1904 (2003). https://doi.org/10.1007/s00464-003-8810-9

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