title: Routine Postoperative Monitoring after Bariatric Surgery in Morbidly Obese Patients with Severe Obstructive Sleep Apnea: ICU Admission is not Necessary.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) occurs in 70-80% of bariatric surgery patients. Patients with severe OSA (apnea/hypopnea index (AHI) >30/h) are postoperatively admitted to an intensive care unit (ICU) for continuous monitoring, to prevent complications. The aim of this study was to assess the necessity of routine postoperative monitoring at an ICU of severe OSA patients after bariatric surgery, attempting to prevent and detect cardiorespiratory complications.
  
  
  METHODS
  Patients undergoing bariatric surgery from November 2010 to July 2013 were entered into a database. Minimal follow-up was 1 month. Poly(somno)graphy (P(S)G) was routinely performed. Patients with severe OSA were admitted to the ICU for the first postoperative night. Oxygen saturation was continuously measured. The database was reviewed regarding patient characteristics, CPAP use, re-intubations, desaturations (saturation <90% and severe <85%), and complications.
  
  
  RESULTS
  Severe OSA was present in 151 of the 794 patients, and all 151 were admitted to the ICU. Thirty who underwent revisional surgery were excluded. Forty-seven percent was male, median age was 51 years (27.0-68.0), and median body mass index (BMI) was 46.6 (kg/m(2)) (34.0-77.6). No deaths, re-intubations, or cardiopulmonary complications occurred. Eighty-two (67.8%) patients used continuous positive airway pressure (CPAP). Twenty-one (17.4%) patients experienced desaturations with a median of 2.0 (1-8). Six patients (5.0%) had one episode of severe desaturation.
  
  
  CONCLUSIONS
  Patients with severe OSA and adequate CPAP use are at low risk of cardiopulmonary complications after (laparoscopic) bariatric surgery. Routine admission to an ICU might be superfluous. However, continuous digital oximetry remains essential.
authors.affiliation: Department of Surgery, Sint Lucas Andreas Ziekenhuis, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
authors.forename: Amin B
authors.initials: AB
authors.lastname: Goucham
authors.affiliation: Department of Surgery, Sint Lucas Andreas Ziekenhuis, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. usha.coblijn@gmail.com.
authors.forename: Usha K
authors.identifier: http://orcid.org/0000-0002-2697-2604
authors.initials: UK
authors.lastname: Coblijn
authors.affiliation: Department of Anesthesiology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Helga B
authors.initials: HB
authors.lastname: Hart-Sweet
authors.affiliation: Department of Otolaryngology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Nico
authors.initials: N
authors.lastname: de Vries
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Sjoerd M
authors.initials: SM
authors.lastname: Lagarde
authors.affiliation: Department of Surgery, Sint Lucas Andreas Ziekenhuis, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
authors.forename: Bart A
authors.initials: BA
authors.lastname: van Wagensveld
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D045422:Continuous Positive Airway Pressure; D003422:Critical Care; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009017:Morbidity; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D010092:Oximetry; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000209:etiology
keywords: Anesthesia; Bariatric surgery; Complications; Desaturations; Intensive care unit, ICU; Monitoring; Sleep apnea