Utilization of intensive care resources in bariatric surgery.
BACKGROUND
Obese patients occasionally require either elective or emergency critical care services following bariatric surgery. We describe this subgroup of patients.


METHODS
From July 1, 1991 to July 31, 2004, we performed 1,279 bariatric operations; 241 (19%) required admission to the surgical critical care service. We retrospectively reviewed medical records for gender, body mass index (BMI), age, whether the operation was initial or revisional, and whether critical care admission was elective or emergent. 3 complication clusters (thromboembolic, pulmonary, and anastomotic) were identified using discharge ICD-9 codes. The costs and length of stay of these subpopulations was calculated.


RESULTS
Patients were on average 46+/-10 years old, with BMI 59+/-13. Critical care admission was emergent in 52.7% (n=127) of cases. Revisional cases did not differ from the initial cases in BMI (56.4 vs 59.2, P=0.42) and they were no more likely to require emergent critical care admission than initial cases (P=0.16). Revisional cases were hospitalized longer (27.2+/-25.6 vs 12.5+/-18.7 days, P=0.003); had higher total hospital costs (US$ 60,631+/-78,337 vs 27,697+/-52,351, P=0.025); and were more likely to die from their complications (revisional surgery mortality 6.5% vs 1.9% for initial surgery [P=0.002]).


CONCLUSIONS
An increasing number of surgical revisions will likely accompany the recent increase in popularity of bariatric surgery. In our experience, these patients require significant critical care services, and have longer, complicated, and more costly hospitalizations.
Cendán
Juan Carlos
JC
Department of Surgery, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
Abu-aouf
Dolan
D
Gabrielli
Andrea
A
Caruso
Lawrence J
LJ
Rout
William Robert
WR
Hocking
Michael P
MP
Layon
A Joseph
AJ
D000714:Anastomosis, Surgical / Q000009:adverse effects; D050110:Bariatric Surgery / Q000009:adverse effects; D015992:Body Mass Index; D003422:Critical Care / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000191:economics / Q000601:surgery*; D011183:Postoperative Complications / Q000628:therapy*; D012086:Reoperation; D012140:Respiratory Tract Diseases / Q000209:etiology / Q000628:therapy; D013923:Thromboembolism / Q000209:etiology / Q000628:therapy