title: Factors associated with length of stay in intensive care after bariatric surgery.
abstract: BACKGROUND
  Although uncommon, admission to the intensive care unit (ICU) after bariatric surgery may be necessary. This study evaluates characteristics of bariatric surgery patients that are admitted to the ICU, and identifies possible risk factors for increased ICU length of stay (LOS).
  
  
  METHODS
  Academic hospital, United States.
  
  
  METHODS
  A retrospective review of all ICU admissions after bariatric surgery from 2006 to 2013 was performed. Demographic characteristics and perioperative data were extracted, and risk factors for the LOS and mortality in the ICU were analyzed.
  
  
  RESULTS
  In total, 124 out of 4398 (2.8%) patients were admitted to the ICU after bariatric surgery. The mean age of these patients was 52.7±11.8 years and included 79 female patients (64%). There were 19 nonemergent or planned admissions (15.3%) and 105 unplanned admissions (84.7%). Mean body mass index was 47.8±12.2 kg/m2, and mean American Society of Anesthesiology (ASA) score was 3.1±0.6. Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding were performed in 80 (65%), 18 (15%), and 6 (5%) patients, respectively. Revisional procedures were performed in 15 (12%) patients. Respiratory failure was the most common cause for admission, occurring in 35 (28.2%) patients. The most common surgical complications requiring ICU admission were bleeding (n = 27) and anastomotic leak (n = 21). Mean ICU LOS was 6.0±9.6 (1-65) days. Mortality occurred in 5 (4.0%) patients. Based on univariate analysis, risk factors associated with ICU LOS were conversion from laparoscopic to open approach, anastomotic leak, time from operation to ICU admission, and reoperation. Higher ASA score was a significant risk factor for mortality.
  
  
  CONCLUSIONS
  ICU admission after bariatric surgery is uncommon but is associated with a significantly increased mortality. Anastomotic leak, conversions, time from operation to ICU admission, and reoperation have the greatest impact in determining the LOS in the ICU after bariatric surgery.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Dvir
authors.initials: D
authors.lastname: Froylich
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio; Fundació Clínic per la Recerca Biomèdica. Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Corcelles
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Matthew
authors.initials: M
authors.lastname: Davis
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mena
authors.initials: M
authors.lastname: Boules
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Daigle
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: BRETHAS@ccf.org.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology / Q000401:mortality; D050110:Bariatric Surgery / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D012086:Reoperation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States
keywords: Bariatric surgery; Intensive care; Length of stay; Morbid obesity; Morbidity