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Improving Bed Utilization in a Cohort of Bariatric Surgical Patients Using a Perioperative Obstructive Sleep Apnea Treatment and Bed Triage Protocol

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Obesity Surgery Aims and scope

Abstract

Background

Postoperative bariatric management often includes high-intensity monitoring for respiratory complications since > 70% of patients have obstructive sleep apnea. Given the increasing number of bariatric surgeries, there is a need to determine safe and cost-effective processes for postoperative care.The objective of this study was to determine if a novel triage and perioperative management guideline reduces postoperative monitoring and costs following bariatric surgery.

Methods

Using a pre-post design, this is a retrospective analysis of 501 patients who had bariatric surgery. Half the patients were managed with usual care, and the other half received obstructive sleep apnea screening and treatment of moderate/severe obstructive sleep apnea with perioperative continuous positive airway pressure. The intervention group was triaged preoperatively to a postoperative nursing location based on risk factors.

Results

There were no significant differences in demographics, comorbidities, frequency, or severity of OSA between groups. In the intervention group, there were fewer admissions to the intensive care unit (2.0% vs 9.1%; p < 0.01) and high acuity unit (9.6% vs 18.3%; p < 0.01). The length of stay was shorter in the intervention group (1.3 vs 2.3 days; p < 0.01) with a 50% reduction in costs. There were no statistically significant differences in the incidence of postoperative respiratory and non-respiratory complications between the two groups.

Conclusions

Most postoperative bariatric surgery patients can be safely managed on the surgical ward with monitoring of routine vitals alone if patients with moderate/severe obstructive sleep apnea receive perioperative continuous positive airway pressure.

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Acknowledgements

We thank the PACU nurses and staff at the Richmond Metabolic and Bariatric Surgery Program for participation in this study.

Funding

We thank the Richmond Hospital Foundation for financial support.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Author information

Authors and Affiliations

  1. Faculty of Medicine, The University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada

    Stephanie L. Alexis

  2. Department of Anesthesiology, The Richmond Hospital, 7000 Westminster Highway, Richmond, BC, V6X 1A2, Canada

    Paul N. Draper & Sonia Makky

  3. Richmond Metabolic & Bariatric Surgery Program, 120-6091 Gilbert Road, Richmond, BC, V7C 5L9, Canada

    David Harris & Nam Nguyen

  4. School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada

    Jason Sutherland

  5. Centre for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    James A. Russell

  6. Richmond Metabolic & Bariatric Surgery Program, 120-6091 Gilbert Road, Richmond, BC V7C 5L9, Richmond, BC, V7C 5L9, Canada

    Sharadh Sampath & Iqbal H. Ahmed

Authors
  1. Stephanie L. Alexis
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  2. Paul N. Draper
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  3. David Harris
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  4. Jason Sutherland
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  5. Sonia Makky
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  6. Nam Nguyen
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  7. James A. Russell
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  8. Sharadh Sampath
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  9. Iqbal H. Ahmed
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Corresponding author

Correspondence to Iqbal H. Ahmed.

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Key Points:

• A pre-bariatric bed location guideline can reduce utilization of postoperative intensive care.

• Treatment of obstructive sleep apnea can reduce monitoring requirements after bariatric surgery.

• A pre-bariatric bed location guideline combined with perioperative treatment of obstructive sleep apnea can reduce in-patient costs of bariatric surgery.

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Alexis, S.L., Draper, P.N., Harris, D. et al. Improving Bed Utilization in a Cohort of Bariatric Surgical Patients Using a Perioperative Obstructive Sleep Apnea Treatment and Bed Triage Protocol. OBES SURG 32, 1926–1934 (2022). https://doi.org/10.1007/s11695-022-06001-3

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  • DOI: https://doi.org/10.1007/s11695-022-06001-3

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