title: Continuous positive airway pressure in immediate postoperative period after laparoscopic Roux-en-Y gastric bypass: is it safe?
abstract: BACKGROUND
  Obstructive sleep apnea is a common condition in the morbidly obese population. Many patients undergoing bariatric surgery require postoperative continuous positive airway pressure (CPAP) therapy. Few data have been published evaluating gastrointestinal anastomotic morbidity in patients receiving CPAP therapy immediately after laparoscopic Roux-en-Y gastric bypass (LRYGB). The objective of the present study was to examine the short-term morbidity of postoperative CPAP in patients after LRYGB in a research setting.
  
  
  METHODS
  We retrospectively reviewed a prospectively collected database of 310 patients who underwent LRYGB from June 2005 to August 2006. The hospital and office charts and respiratory treatment records were reviewed from the completion of surgery until the first postoperative visit at 2 weeks. The data collected included age, gender, body mass index, presence of obstructive sleep apnea, in-patient CPAP use, and perioperative complications. Patients were divided into 2 groups: those who used immediate postoperative CPAP therapy and those who did not. Patients requiring revisional surgery and other bariatric procedures were excluded from the present series.
  
  
  RESULTS
  Postoperative CPAP was required by 91 patients (29.3%) and 219 did not use CPAP (70.7%). The mean patient age was 47.2 and 43.9 years (P <.01), and the average body mass index was 52 and 46.4 kg/m(2) in the groups that did and did not require CPAP postoperatively, respectively (P <.0001). No anastomotic leaks occurred in either group, and the most common in-hospital complication, seen in 7 patients (2.2%), was basal atelectasis (3 in the postoperative CPAP group; P >.05), followed by wound infection in 4 patients overall (1.2%; 3 patients in the postoperative CPAP group; P >.05) and gastrointestinal bleeding in 1 patient (.32%) in the group without postoperative CPAP. The difference in overall morbidity, unrelated to the integrity of the anastomosis, between those who used CPAP postoperatively and those who did not was not significant (4.5% versus 3.6%, respectively; P >.05).
  
  
  CONCLUSIONS
  The use of CPAP after LRYGB did not result in increased the morbidity in our patient series.
authors.affiliation: Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ramirez
authors.forename: Peter F
authors.initials: PF
authors.lastname: Lalor
authors.forename: Samuel
authors.initials: S
authors.lastname: Szomstein
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome