Postoperative CPAP and BiPAP use can be safely omitted after laparoscopic Roux-en-Y gastric bypass
Abstract
Background Obstructive sleep apnea (OSA) is prevalent in the morbidly obese population. The need for routine preoperative testing for OSA has been debated in bariatric surgery publications. Most investigators have advocated the use of continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) in the postoperative setting; however, others have reported pouch perforations or other gastrointestinal complications as a result of their use. From a review of our experience, we present an algorithm for the safe postoperative treatment of patients with OSA without the use of CPAP or BiPAP.Methods From January 2003 to December 2007, 1095 laparoscopic Roux-en-Y gastric bypasses were performed at our institution. Preoperative testing for OSA was not routinely performed. A prospective database was maintained. The data included patient demographics, co-morbidities (including OSA and CPAP/BiPAP use), perioperative events, complications, and follow-up information. Patients with known OSA were not given CPAP/BiPAP after surgery. They were observed in a monitored setting during their inpatient stay, ensuring continuous oxygen saturation of >92%. All patients used patient-controlled analgesia, were trained in the use of incentive spirometry, and ambulated within a few hours of surgery. The outcomes were compared between the OSA patients using preoperative CPAP/BiPAP versus those with OSA without preoperative CPAP/BiPAP versus patients with no history of OSA.Results A total of 811 patients were included in the study group with no known history of OSA. Of the 284 patients with a confirmed diagnosis of OSA, 144 were CPAP/BiPAP dependent. Statistically significant differences were present in age distribution and gender, with men having greater CPAP/BiPAP dependency. No significant differences were found in body mass index, length of stay, pulmonary complications, or deaths. One pulmonary complication occurred in the OSA, CPAP/BiPAP-dependent group, three in the OSA, non-CPAP group, and six in the no-known OSA group. No anastomotic leaks or deaths occurred in the series.Conclusion Postoperative CPAP/BiPAP can be safely omitted in laparoscopic Roux-en-Y gastric bypass patients with known OSA, provided they are observed in a monitored setting and their pulmonary status is optimized by aggressive incentive spirometry and early ambulation.
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Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69).
“Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69) or hypoxemia (WMD − 3.8%, 95% CI − 5.4% to − 2.2%) [45–59].”
Meta-analysis of observational studies suggested higher odds of postoperative pneumonia (OR 0.24, 95% CI 0.07 to 0.82) with perioperative CPAP.
“Meta-analysis of observational studies suggested higher odds of postoperative pneumonia (OR 0.24, 95% CI 0.07 to 0.82), a trend towards lower odds of reintubation (OR 0.28, 95% CI 0.07 to 1.04), and shorter hospital stay (WMD − 1.6 days, 95% CI − 1.83 to − 1.28) albeit relevant evidence was of low certainty due to imprecision and the observational study design (Supplementary Table S7) [51, 52, 60,”
Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain hypoxemia (WMD −3.8%, 95% CI −5.4% to −2.2%).
“Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69) or hypoxemia (WMD − 3.8%, 95% CI − 5.4% to − 2.2%) [45–59].”
Meta-analysis of observational studies suggested shorter hospital stay with perioperative CPAP (WMD −1.6 days, 95% CI −1.83 to −1.28).
“Meta-analysis of observational studies suggested higher odds of postoperative pneumonia (OR 0.24, 95% CI 0.07 to 0.82), a trend towards lower odds of reintubation (OR 0.28, 95% CI 0.07 to 1.04), and shorter hospital stay (WMD − 1.6 days, 95% CI − 1.83 to − 1.28) albeit relevant evidence was of low certainty due to imprecision and the observational study design (Supplementary Table S7) [51, 52, 60,”
Meta-analysis of observational studies suggested a trend towards lower odds of reintubation with perioperative CPAP (OR 0.28, 95% CI 0.07 to 1.04).
“Meta-analysis of observational studies suggested higher odds of postoperative pneumonia (OR 0.24, 95% CI 0.07 to 0.82), a trend towards lower odds of reintubation (OR 0.28, 95% CI 0.07 to 1.04), and shorter hospital stay (WMD − 1.6 days, 95% CI − 1.83 to − 1.28) albeit relevant evidence was of low certainty due to imprecision and the observational study design (Supplementary Table S7) [51, 52, 60,”
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- Authors
- Jensen, C., Tejirian, T., Lewis, C., Yadegar, J., Dutson, E., & Mehran, A.
- Affiliations
- University of California, Los Angeles (US)
- Corresponding author
- Jensen, Candice
- Venue
- Surgery for Obesity and Related Diseases
- Publisher
- Elsevier BV
- Published
- 2008-07
- Volume
- 4
- Issue
- 4
- Pages
- 512-514
- ISSN
- 1550-7289 (ISSN-L)
- OpenAlex
- W2165349019
- Cited by
- 79
- References
- 14
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 3 · 2017: 4 · 2016: 12 · 2015: 6 · 2014: 5 · 2013: 6 · 2012: 10
- FWCI
- 5.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Surgery for Obesity and Related Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- obstructive sleep apnea, laparoscopic Roux-en-Y gastric bypass
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Early Ambulation, Female, Humans, Male, Middle Aged, Obesity, Morbid, Laparoscopy, Postoperative Care, Prospective Studies, Sex Factors, Spirometry, Gastric Bypass, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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