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The effect of postoperative CPAP use on anastomotic and staple line leakage after bariatric surgery

  • ENT • Original Article
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Abstract

Purpose

Almost two-thirds of the population undergoing bariatric surgery (BS) suffers from obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) is the standard treatment for moderate to severe OSA and is recommended in patients undergoing BS perioperatively. A severe and dreaded complication after BS is anastomotic leakage. There is theoretical concern that perioperative CPAP use may result in increased distension of the gastrointestinal tract and increase the risk of developing an anastomotic leakage. The aim of this study was to evaluate the effect of postoperative CPAP use on the risk of developing anastomotic leakages after BS.

Methods

Retrospectively, all patients from a single bariatric center who underwent BS from November 2007 to August 2019 were included. Presence and severity of OSA were determined using poly(somno)graphy. To evaluate the effect of postoperative CPAP use on anastomotic leakage, a multivariable logistic regression analysis was performed.

Results

A total of 4052 patients were included, with OSA being diagnosed in 62%. Overall, 970 patients (24%) used CPAP after BS. Anastomotic leakage occurred in 64 (1.6%) patients after BS. Leakage rate was 1.3% in non-CPAP group versus 2.5% in CPAP group (p = 0.01). CPAP use was associated with anastomotic leakage; however, after adjustment, CPAP use was not an independent predictor (OR = 1.40, 95% CI 0.60–3.28, p = 0.44).

Conclusion

There is no independent relation between postoperative CPAP use and anastomotic leakage after BS. Only revision surgery was an independent predictor of anastomotic leakage.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands

    Stefanie N. H. Reijers, Pien F. N. Bosschieter, Madeline J. L. Ravesloot & Nico de Vries

  2. Department of Surgery, OLVG, Amsterdam, The Netherlands

    Leontien M. G. Nijland, Ruben N. van Veen & Steve M. M. de Castro

  3. Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands

    Christel A. L. de Raaff

  4. Department of Oral Kinesiology, ACTA, Amsterdam, The Netherlands

    Nico de Vries

  5. Department of Otorhinolaryngology, University of Antwerp, Antwerp, Belgium

    Nico de Vries

Authors
  1. Stefanie N. H. Reijers
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  2. Leontien M. G. Nijland
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  3. Pien F. N. Bosschieter
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  4. Christel A. L. de Raaff
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  7. Steve M. M. de Castro
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Correspondence to Stefanie N. H. Reijers.

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The authors declare that they have no conflict of interest.

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Local approval from the board of directors of the OLVG was received for this study. Because this research study was conducted retrospectively from data obtained for clinical purposes, there was no approval needed from the Medical Ethical Committee (METC).

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This was a retrospective study based on records, and formal consent was not required.

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Reijers, S.N.H., Nijland, L.M.G., Bosschieter, P.F.N. et al. The effect of postoperative CPAP use on anastomotic and staple line leakage after bariatric surgery. Sleep Breath 25, 1037–1043 (2021). https://doi.org/10.1007/s11325-020-02199-7

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  • DOI: https://doi.org/10.1007/s11325-020-02199-7

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