title: Obstructive sleep apnea can be safely managed in a level 2 critical care setting after laparoscopic bariatric surgery.
abstract: BACKGROUND
  In the United Kingdom, demand for intensive care beds (level 3 critical care) often outstrips supply, leading to frequent and frustrating cancellation of complex elective surgery. It has been suggested that patients with obstructive sleep apnea who undergo bariatric surgery should be admitted to a level 3 facility for routine postoperative management. We have questioned the validity of this dogma in the era of laparoscopic bariatric surgery by using a simple easily applicable algorithm.
  
  
  OBJECTIVE
  The aim of this study was to investigate the clinical outcome of patients with obstructive sleep apnea (OSA) without admission to the intensive care unit after laparoscopic bariatric surgery.
  
  
  METHODS
  For the first 24 hours after surgery, all patients were admitted to a level 2 (high-dependency) area on a general surgical ward with experience of bariatric surgery. They received supplemental oxygen, continuous pulse oximetry, and judicious analgesic administration using a combination of small boluses of i.v. morphine together with i.v. paracetamol. Perioperative continuous positive airway pressure support was not routinely given, unless patients with OSA had oxygen saturation below their recorded preoperative level on 2 consecutive readings.
  
  
  RESULTS
  A total of 1623 patients underwent laparoscopic bariatric surgery over a 12-year period. Of those, 192 had OSA with a median operative body mass index of 52 kg/m(2) (range 34-78 kg/m(2)). The incidence of respiratory complications and the median length of stay (3 nights) were identical in patients with OSA and those without OSA. Four patients self-administered perioperative continuous positive airway pressure, but none required transfer to intensive care or mechanical ventilation. There were no in-hospital deaths.
  
  
  CONCLUSIONS
  Laparoscopic bariatric surgery in patients with OSA is well tolerated and does not require the routine use of level 3 critical care facilities.
authors.affiliation: Phoenix Health, Ruthin, United Kingdom.
authors.forename: Euan
authors.initials: E
authors.lastname: Shearer
authors.forename: Conor J
authors.initials: CJ
authors.lastname: Magee
authors.forename: Carmen
authors.initials: C
authors.lastname: Lacasia
authors.forename: David
authors.initials: D
authors.lastname: Raw
authors.forename: David
authors.initials: D
authors.lastname: Kerrigan
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000379:methods; D003422:Critical Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006757:Hospital Units; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D010092:Oximetry; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D006113:United Kingdom