CHICAGO — Mandatory screening for obstructive sleep apnea can significantly reduce the need for intensive care unit admission following bariatric surgery, Dr. Peter T. Hallowell said at the annual meeting of the Central Surgical Association.
“In our center, mandatory screening and aggressive preoperative treatment for sleep apnea has actually eliminated the need for respiratory-related ICU stay,” said Dr. Hallowell of the department of surgery, Case Western Reserve University, and the bariatric surgery program at University Hospitals Case Medical Center, both in Cleveland.
Previous studies have suggested that approximately 20% of patients have ICU stays following bariatric surgery, and sleep apnea—prevalent among the morbidly obese—is associated with increased postoperative complications such as respiratory distress.
“We have long suspected that sleep apnea is underdiagnosed in the bariatric population, so we did a retrospective review of our bariatric database from 1998 to 2005, comparing the era of selective screening with the era of mandatory screening,” Dr. Hallowell said.
Mandatory screening was implemented in 2004. All patients underwent an overnight polysomnogram and, if apnea was detected, continuous positive airway pressure therapy was instituted.
Before undergoing bariatric surgery, patients also are required to participate in an extensive education program, to stop smoking, and to begin exercising.
For a comparison of the effect of preoperative sleep apnea screening, patients were divided into two groups. Group 1 included the 572 patients who had gastric bypass between 1998 and December 2003; group 2 included the 318 who had the surgery between January 2004, when mandatory screening was instituted, and December 2005.
The groups were well matched in terms of demographics and comorbidities. Mean body mass index was 51.1 kg/m
Among the patients in group 1, there were 11 ICU admissions for respiratory problems and 21 for other complications such as leaks, bleeds, or obstruction either intraoperatively or postoperatively. In group 2, there were 11 ICU admissions in all, none of which were for respiratory complications, Dr. Hallowell said.
The difference in respiratory-related admissions between the two groups was statistically significant.
The average length of stay among patients admitted to the ICU was 12 days, compared with 2.8 days for those who did not require admission.
Multiple factors, including increased surgical experience, patient education, and the requirement for smoking cessation have led to a decrease in the need for ICU admission following bariatric surgery. “Our study shows that recognizing and treating occult sleep apnea further improves this quality metric,” Dr. Hallowell said.
Audience member Dr. Henry Buchwald of the University of Minnesota, Minneapolis, asked about patients who have had the procedure since the study cutoff in 2005. “At present, we now have 414 patients in group 2 and still have had no respiratory admissions,” Dr. Hallowell replied.
Dr. Buchwald also asked about the cost of sleep apnea screening. “The expense for evaluation and treatment of sleep apnea is approximately $5,000, while the cost for the ICU is about $3,000 a day without a ventilator or critical care consult,” Dr. Hallowell said.