Determinants of the need for intensive care and prolonged mechanical ventilation in patients undergoing bariatric surgery.
BACKGROUND
Bariatric surgery at the upper extremes of weight can be associated with serious postoperative complications. In many cases, these complications will require the availability of critical care resources. The purpose of this study is to examine factors that increase the likelihood for prolonged postoperative intensive care unit (ICU) and extended mechanical ventilation (MV) >24 hours.


METHODS
A retrospective chart review was conducted of all patients undergoing bariatric surgery over a 7-year period at a tertiary care academic institution. There were 250 total patients undergoing either vertical banded gastroplasty (n=15) or Roux-en-Y gastric bypass (n=235). Age, Gender, BMI, pulmonary co-morbidity, revisional surgery (previous bariatric operations), and need for reoperation for suspected intra-abdominal complications were examined by univariate and multivariate analyses.


RESULTS
Mean age was 43.6+/-10.6 years and mean BMI 56+/-10.6 kg/m2. Pulmonary co-morbidity was present in 123/250 patients (49%), 42/250 (17%) had revisional surgery, and 21/250 (8%) required reoperation. ICU care was required in 60 patients (24%). By univariate analysis, age >50 yrs (P=0.047), male gender (P=0.038), and need for reoperation (P <0.001) were associated with need for ICU. By multivariate analysis, BMI >60 kg/m2, odds ratio (OR) 2.25, 95% confidence Interval (CI) 1.11-4.60, P=0.04, and need for reoperation, OR 39.8, 95% CI 10.41-264.7, P <0.0001, were associated with need for ICU. MV >24 hrs was required in 44 patients (18%). By univariate analysis, BMI >60 kg/m2 (P=0.013), pulmonary co-morbidity (P=0.014), male gender (P =0.029), and reoperation (P <0.0001) were associated with need for MV. By multivariate analysis, BMI >60 kg/m2, OR 3.1, 95% CI 1.44-7.13, P=0.005, and need for reoperation, OR 22.3, 95% CI 7.4-79.2, P <0.0001, were associated with need for MV.


CONCLUSIONS
Patients who are male, older (>50 yrs), heavier (BMI >60 kg/m2), and who have complications requiring reoperation will likely need intensive care. Additionally, males, heavier patients (BMI >60 kg/m2), pulmonary co-morbidity, and need for reoperation may warrant need for extended MV. Surgeons and hospitals should consider this when planning resources for bariatric surgery programs.
Helling
Thomas S
TS
Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64111, USA. thelling@carondelet.com
Willoughby
Thomas L
TL
Maxfield
Daniel M
DM
Ryan
Patricia
P
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D015992:Body Mass Index; D015897:Comorbidity; D003422:Critical Care / Q000379:methods*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors