title: Eliminating respiratory intensive care unit stay after gastric bypass surgery.
abstract: BACKGROUND
  The bariatric patient is among the most complex in general surgery. Morbid obesity and associated comorbidities create a higher likelihood for intensive care unit (ICU) services. Obstructive sleep apnea (OSA) is often unrecognized and may contribute to increased respiratory events and ICU admissions. Identifying and treating occult OSA may decrease the need for ICU utilization. This retrospective review attempts to evaluate this hypothesis.
  
  
  METHODS
  From 1998 to 2005, 890 bariatric procedures were performed at our center: 858 primary gastric bypasses and 32 revisions. Before 2004, patients were evaluated selectively for OSA; after 2004, all patients have had a sleep study.
  
  
  RESULTS
  A postoperative ICU stay was required in 43 patients (5%). From 1998 to 2003, when OSA evaluation was not mandatory, a respiratory-related ICU stay was necessary in 11 of 572 patients. When OSA evaluation was mandated in all patients (2004-2005), there was one respiratory related ICU stay (1/318).
  
  
  CONCLUSIONS
  Multiple variables lead to a decrease in ICU stay. Our study suggests that recognizing and treating occult sleep apnea may further improve this quality metric. In our center, mandatory OSA screening and aggressive preoperative treatment have eliminated the need for respiratory-related ICU stays after bariatric surgery.
authors.affiliation: University Hospitals Case Medical Center Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. peter.hallowell@uhhospitals.org
authors.forename: Peter T
authors.initials: PT
authors.lastname: Hallowell
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Stellato
authors.forename: Marianna C
authors.initials: MC
authors.lastname: Petrozzi
authors.forename: Margaret
authors.initials: M
authors.lastname: Schuster
authors.forename: Kristen
authors.initials: K
authors.lastname: Graf
authors.forename: Ann
authors.initials: A
authors.lastname: Robinson
authors.forename: John J
authors.initials: JJ
authors.lastname: Jasper
mesh_terms: D000328:Adult; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D005260:Female; D015390:Gastric Bypass / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011300:Preoperative Care; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*