title: Risk factors for acute respiratory failure in bariatric surgery: data from the Nationwide Inpatient Sample, 2006-2008.
abstract: BACKGROUND
  Acute respiratory failure (ARF) can be a life-threatening postoperative complication after bariatric surgery and is defined as the presence of acute respiratory distress or pulmonary insufficiency. We sought to identify predictors of ARF in patients who underwent bariatric surgery.
  
  
  METHODS
  Using the Nationwide Inpatient Sample database, from 2006 to 2008, the clinical data from morbidly obese patients who underwent bariatric surgery were examined. Multivariate regression analysis was performed to identify the independent factors predictive of ARF. The factors examined included patient characteristics, co-morbidities, payer type, teaching status of hospital, surgical techniques (laparoscopic versus open), and type of bariatric operation (gastric bypass versus nongastric bypass).
  
  
  RESULTS
  A total of 304,515 patients underwent bariatric surgery during the 3-year period. The overall ARF rate was 1.35%. The greatest rate of ARF (4.10%) was observed after open gastric bypass surgery. The ARF rate was lower after laparoscopic than after the open surgical technique (.94% versus 3.87%, respectively; P < .01) and after nongastric bypass versus gastric bypass (.82% versus 1.54%, respectively; P < .01). Using multivariate regression analysis, congestive heart failure (adjusted odds ratio [AOR] 5.1), open surgery (AOR 3.3), chronic renal failure (AOR 2.9), gastric bypass (AOR 2.5), peripheral vascular disease (AOR 2.4), male gender (AOR 1.9), age >50 years (AOR 1.8), Medicare payer (AOR 1.8), alcohol abuse (AOR 1.8), chronic lung disease (AOR 1.6), diabetes mellitus (AOR 1.2), and smoking (AOR 1.1) were factors associated with greater rates of ARF. Compared with patients without ARF, patients with ARF had significantly greater in-hospital mortality (5.69% versus .04%, P < .01).
  
  
  CONCLUSIONS
  We identified multiple risk factors that have an effect on the development of acute respiratory failure after bariatric surgery. Surgeons should consider these factors in surgical decision-making and inform patients of their risk of this potentially life-threatening complication.
authors.affiliation: Department of Surgery, University of California, Irvine School of Medicine, Irvine, California, USA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Masoomi
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Reavis
authors.forename: Brian R
authors.initials: BR
authors.lastname: Smith
authors.forename: Hubert
authors.initials: H
authors.lastname: Kim
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
mesh_terms: D000208:Acute Disease; D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000706:statistics & numerical data; D008297:Male; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D012044:Regression Analysis; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology