title: Increasing body mass index and the incidence of intraoperative hypoxemia.
abstract: OBJECTIVE
  Obese patients regularly present for surgery and have greater hypoxemia risk. This study aimed to identify the risk and incidence of intraoperative hypoxemia with increasing body mass index (BMI).
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  METHODS
  Operating room.
  
  
  METHODS
  A total of 15,238 adult patients who underwent general anesthesia for elective noncardiac surgery at a single large urban academic institution between January 2013 and December 2014.
  
  
  METHODS
  Unadjusted and risk-adjusted logistic regression analyses explored the relationship between increasing categories of BMI and intraoperative hypoxemia, severe hypoxemia, and prolonged hypoxemia.
  
  
  METHODS
  Intraoperative pulse oximeter readings and preoperative patient characteristics.
  
  
  RESULTS
  With normal BMI, 731 (16%) patients experienced hypoxemia compared with 1150 (28%) obese patients. Adjusted odds ratio (AOR) of intraoperative hypoxemia increased with each category of BMI from 1.27 (95% confidence interval [CI], 1.12-1.44) in overweight patients to 2.63 (95% CI, 2.15-3.23) in patients with class III obesity. AOR of severe hypoxemia was significant with class I obesity (AOR, 1.32; 95% CI, 1.08-1.60), class II obesity (AOR, 2.01; 95% CI, 1.59-2.81), and class III obesity (AOR, 2.27; 95% CI, 1.75-2.93). AOR of prolonged hypoxemia increased with BMI from 3.29 (95% CI, 1.79-6.23) with class I obesity to 9.20 (95% CI, 4.74-18) with class III obesity.
  
  
  CONCLUSIONS
  Despite existing practices to limit hypoxemia in obese patients, the odds of experiencing intraoperative hypoxemia increase significantly with increasing categories of BMI. Further practices may need to be developed to minimize the risk of intraoperative hypoxemia in obese patients.
authors.affiliation: Department of Anesthesiology, Perioperative Care, & Pain Medicine, New York University School of Medicine, 550 First Ave, New York, NY 10016. Electronic address: Samir.kendale@nyumc.org.
authors.forename: Samir M
authors.initials: SM
authors.lastname: Kendale
authors.affiliation: Department of Anesthesiology, Perioperative Care, & Pain Medicine, New York University School of Medicine, 550 First Ave, New York, NY 10016.
authors.forename: Jeanna D
authors.initials: JD
authors.lastname: Blitz
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D015992:Body Mass Index; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D010092:Oximetry; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity
keywords: Anesthesia, general; Body mass index; Obesity; Retrospective studies; Risk