title: Do Changes in Perioperative and Postoperative Treatment Protocol Influence the Frequency of Pulmonary Complications? A Retrospective Analysis of Four Different Bariatric Groups.
abstract: The current understanding of prophylaxis of pulmonary complications in bariatric surgery is weak.
  
  
  
  The aim of this study was to observe how changes in perioperative and postoperative treatments affect the incidence of pulmonary complications in bariatric patients.
  
  
  
  This is a retrospective clinical study of 400 consecutive bariatric patients. The patients, who either underwent a sleeve gastrectomy or a Roux-en-Y gastric bypass, were divided consecutively into four subgroups with different approaches to perioperative treatment.
  
  
  
  The first group (patients 0-100) was recovered in the intensive care unit with minimal mobilization (ICU). They had a urinary catheter and a drain. The second group (patients 101-200) was similar to the first group, but the patients used a continuous positive airway pressure (CPAP) device intermittently (ICU-CPAP). The third group (patients 201-300) was recovered on a normal ward without a urinary catheter or a drain and used a CPAP device (ward-slow). The fourth group (patients 301-400) walked to the operating theater and was mobilized in the recovery room during the first 2 h after the operation (ward-fast). CPAP was also used. Primary endpoints were pulmonary complications, pneumonia, and infection, non-ultra descriptus (NUD).
  
  
  
  The number of pulmonary complications among the groups was significantly different. A long operation time increased the risk for infection (p < 0.001 95 % CI from 2.02 to 6.59 %).
  
  
  
  Operation time increases the risk for pulmonary complications. Changes in perioperative care toward the ERAS protocol may have a positive effect on the number of pulmonary complications.
authors.affiliation: Peijas Hospital, HUS, Lohja, Finland. mervi.javanainen@hus.fi.
authors.forename: Mervi Hannele
authors.initials: MH
authors.lastname: Javanainen
authors.affiliation: Peijas Hospital, HUS, Lohja, Finland.
authors.forename: Tom
authors.initials: T
authors.lastname: Scheinin
authors.affiliation: Peijas Hospital, HUS, Lohja, Finland.
authors.forename: Harri
authors.initials: H
authors.lastname: Mustonen
authors.affiliation: Peijas Hospital, HUS, Lohja, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Leivonen
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D002985:Clinical Protocols; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D019990:Perioperative Care; D011184:Postoperative Period; D012189:Retrospective Studies; D055815:Young Adult
keywords: Bariatric surgery; ERAS; Pulmonary complications