title: Incidence and risk factors for intensive care unit admission after bariatric surgery: a multicentre population-based cohort study.
abstract: BACKGROUND
  With increasing rates of bariatric surgery and the consequential involvement of increasingly complex patients, uncertainty remains regarding the use of intensive care unit (ICU) services after bariatric surgery. Our objective was to define the incidence, indications, and outcomes of patients requiring ICU admission after bariatric surgery and assess whether unplanned ICU admission could be predicted using preoperative factors.
  
  
  METHODS
  All adult bariatric surgery patients between 2007 and 2011 in Western Australia were identified from the Department of Health Data Linkage Unit database and merged with a separate database encompassing all subsequent ICU admissions pertaining to bariatric surgery. The minimal and mean follow-up periods were 12 months and 3.4 yr, respectively.
  
  
  RESULTS
  Of the 12 062 patients who underwent bariatric surgery during the study period, 590 patients (4.9%; 650 ICU admissions) were admitted to an ICU after their bariatric surgery. Patients admitted to the ICU were older (48 vs 43 yr, P<0.001), more likely to be male (49.7 vs 20.2%, P<0.001), and more likely to require revisional bariatric surgery (14.4 vs 7.1%, P<0.001). One hundred and seventy-six patients required an emergent unplanned ICU admission, with 51 requiring multiple ICU admissions. Revisional or open surgery, diabetes mellitus, chronic respiratory disease, and obstructive apnoea were the strongest preoperative factors associated with unplanned ICU admission.
  
  
  CONCLUSIONS
  Intensive care unit admission after bariatric surgery was uncommon (4.9% of all patients), with 30.9% of all referrals being unplanned. A nomogram and smartphone application based on five important preoperative factors may assist anaesthetists to conduct preoperative planning for high-risk bariatric surgical patients.
authors.affiliation: Department of Intensive Care Medicine davidintoronto2004@hotmail.com.
authors.forename: D J R
authors.initials: DJ
authors.lastname: Morgan
authors.affiliation: Department of Intensive Care Medicine School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia School of Veterinary and Life Sciences, Murdoch University, 90 South Street, Murdoch, WA 6150, Australia.
authors.forename: K M
authors.initials: KM
authors.lastname: Ho
authors.affiliation: Department of Surgery, St John of God Hospital Subiaco, 12 Salvado Road, Subiaco, WA 6008, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Armstrong
authors.affiliation: Department of Intensive Care Medicine, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, WA 6009, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Baker
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D004630:Emergencies; D005260:Female; D006302:Health Services Research / Q000379:methods; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014904:Western Australia / Q000453:epidemiology
keywords: bariatric surgery; critical care; obesity; postoperative complications