Eliminating respiratory intensive care unit stay after gastric bypass surgery
Abstract
Background The bariatric patient is among the most complex in general surgery. Morbid obesity and associated comorbidities create a higher likelihood for intensive care unit (ICU) services. Obstructive sleep apnea (OSA) is often unrecognized and may contribute to increased respiratory events and ICU admissions. Identifying and treating occult OSA may decrease the need for ICU utilization. This retrospective review attempts to evaluate this hypothesis.Patients and methods From 1998 to 2005, 890 bariatric procedures were performed at our center: 858 primary gastric bypasses and 32 revisions. Before 2004, patients were evaluated selectively for OSA; after 2004, all patients have had a sleep study.Results A postoperative ICU stay was required in 43 patients (5%). From 1998 to 2003, when OSA evaluation was not mandatory, a respiratory-related ICU stay was necessary in 11 of 572 patients. When OSA evaluation was mandated in all patients (2004-2005), there was one respiratory related ICU stay (1/318).Conclusion Multiple variables lead to a decrease in ICU stay. Our study suggests that recognizing and treating occult sleep apnea may further improve this quality metric. In our center, mandatory OSA screening and aggressive preoperative treatment have eliminated the need for respiratory-related ICU stays after bariatric surgery.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 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].”
Cites
The Continuing Epidemics of Obesity and Diabetes in the United States
Mokdad, A. H. (2001) · JAMA · doi:10.1001/jama.286.10.1195 · Cited by 2,730 · see citing works
A Potential Decline in Life Expectancy in the United States in the 21st Century
Olshansky, S. J., Passaro, D. J., Hershow, R. C., Layden, J., Carnes, B. A., Brody, J., Hayflick, L., Butler, R. N., Allison, D. B., & Ludwig, D. S. (2005) · New England Journal of Medicine · doi:10.1056/nejmsr043743 · Cited by 2,612 · see citing works
A Potential Decline in Life Expectancy in the United States in the 21st Century
Olshansky, S. J., Passaro, D. J., Hershow, R. C., Layden, J. E., Carnes, B. A., Brody, J. A., Hayflick, L., Butler, R. N., Allison, D. B., & Ludwig, D. S. (2005) · Obstetrical & Gynecological Survey · doi:10.1097/01.ogx.0000167407.83915.e7 · Cited by 1,944 · see citing works
Annual Deaths Attributable to Obesity in the United States
Allison, D. B. (1999) · JAMA · doi:10.1001/jama.282.16.1530 · Cited by 1,868 · see citing works
Laparoscopic Versus Open Gastric Bypass: A Randomized Study of Outcomes, Quality of Life, and Costs
Nguyen, N. T., Goldman, C. D., Rosenquist, C. J., Arango, A., Cole, C., Lee, S. J., & Wolfe, B. M. (2001) · Annals of Surgery · doi:10.1097/00000658-200109000-00002 · Cited by 1,053 · see citing works
The Risks of Surgery in Obese Patients
Pasulka, P. S., Bistrian, B. R., BENOTTI, P. N., & Blackburn, G. L. (1986) · Annals of Internal Medicine · doi:10.7326/0003-4819-104-4-540 · Cited by 333 · see citing works
Shepard, J. (1992) · Clinics in Chest Medicine · doi:10.1016/s0272-5231(21)00873-x · Cited by 329 · see citing works
Critical Respiratory Events in the Postanesthesia Care Unit
Rose, D., Cohen, M. M., Wigglesworth, D., & DeBoer, D. P. (1994) · Anesthesiology · doi:10.1097/00000542-199408000-00020 · Cited by 298 · see citing works
Evidence Supporting Routine Polysomnography Before Bariatric Surgery
O'Keeffe, T., & Patterson, E. J. (2004) · Obesity Surgery · doi:10.1381/096089204772787248 · Cited by 241 · see citing works
Obesity and its surgical management
Livingston, E. H. (2002) · The American Journal of Surgery · doi:10.1016/s0002-9610(02)00914-5 · Cited by 164 · see citing works
Huerta, S., DeShields, S., Shpiner, R. B., Li, Z., Liu, C., Sawicki, M. P., Arteaga, J. R., & Livingston, E. H. (2002) · Journal of Gastrointestinal Surgery · doi:10.1016/s1091-255x(01)00048-8 · Cited by 156 · see citing works
Critical care of the bariatric patient
Pieracci, F. M., Barie, P. S., & Pomp, A. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000217216.84983.0a · Cited by 128 · see citing works
Perioperative Management of Special Populations: Obesity
DeMaria, E. J., & Carmody, B. J. (2005) · Surgical Clinics of North America · doi:10.1016/j.suc.2005.09.002 · Cited by 97 · see citing works
Potentially life-threatening sleep apnea is unrecognized without aggressive evaluation
Hallowell, P. T., Stellato, T. A., Schuster, M. M., Graf, K., Robinson, A. V., Crouse, C. J., & Jasper, J. J. (2007) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2006.09.022 · Cited by 90 · see citing works
Self-citationHelling, T. S., Willoughby, T. L., Maxfield, D., & Ryan, P. (2004) · Obesity Surgery · doi:10.1381/0960892041975488 · Cited by 74 · see citing works
The Use and Modification of Clinical Pathways to Achieve Specific Outcomes in Bariatric Surgery
Yeats, M., Wedergren, S., Fox, N. M., et al. (2005) · The American Surgeon · doi:10.1177/000313480507100211 · Cited by 49 · see citing works
Utilization of Intensive Care Resources in Bariatric Surgery
Cendan, J. C., Abu-aouf, D., Gabrielli, A., et al. (2005) · Obesity Surgery · doi:10.1381/096089205774512681 · Cited by 38 · see citing works
Open Roux-en-Y gastric bypass in 925 patients without mortality
Obeid, F. N., Falvo, A. J., Dabideen, H., Stocks, J., Moore, M., & Wright, M. (2005) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2004.11.023 · Cited by 32 · see citing works
Two-Day Length of Stay following Open Roux-En-Y Gastric Bypass: is it Feasible, Safe and Reasonable?
Stellato, T. A., Hallowell, P. T., Crouse, C. J., et al. (2004) · Obesity Surgery · doi:10.1381/096089204772787257 · Cited by 19 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Nagappa, M., Liao, P., Wong, J., Auckley, D., Ramachandran, S. K., Memtsoudis, S., Mokhlesi, B., & Chung, F. (2015) · PLOS ONE · doi:10.1371/journal.pone.0143697 · Cited by 684 · see citing works
Di Lorenzo, N., Antoniou, S. A., Batterham, R. L., Busetto, L., Godoroja, D., Iossa, A., Carrano, F. M., Agresta, F., Alarçon, I., Azran, C., et al. (2020) · Surgical Endoscopy · doi:10.1007/s00464-020-07555-y · Cited by 465 · see citing works
Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome
Kaw, R., Chung, F., Pasupuleti, V., Mehta, J., Gay, P. C., & Hernandez, A. V. (2012) · British Journal of Anaesthesia · doi:10.1093/bja/aes308 · Cited by 449 · see citing works
Postoperative complications in patients with obstructive sleep apnea: a meta-analysis
Hai, F., Porhomayon, J., Vermont, L., Frydrych, L., Jaoude, P., & El-Solh, A. A. (2014) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2014.05.010 · Cited by 139 · see citing works
Ravesloot, M. J. L., de Raaff, C. A. L., van de Beek, M. J., Benoist, L. B. L., Beyers, J., Corso, R. M., Edenharter, G., den Haan, C., Heydari Azad, J., Ho, J.-P. T. F., et al. (2019) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2019.1448 · Cited by 58 · see citing works
- Authors
- Hallowell, P. T., Stellato, T. A., Petrozzi, M. C., Schuster, M., Graf, K., Robinson, A., & Jasper, J. J.
- Affiliations
- University Hospitals Cleveland Medical Center (US)
- Corresponding author
- Hallowell, Peter T.
- ORCID
- Hallowell, Peter T.
- Venue
- Surgery
- Publisher
- Elsevier BV
- Published
- 2007-10
- Volume
- 142
- Issue
- 4
- Pages
- 608-612.e1
- ISSN
- 0039-6060 (ISSN-L)
- OpenAlex
- W1971036193
- Cited by
- 37
- References
- 19
- Citations by year
- 2025: 1 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 5 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 8 · 2014: 2 · 2013: 1 · 2012: 3
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Surgery (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
- gastric bypass, bariatric surgery, obstructive sleep apnea, ICU length of stay, postoperative pulmonary complications, preoperative screening, polysomnography, morbid obesity, revisional bariatric surgery
- MeSH terms
- Adult, Female, Humans, Intensive Care Units, Male, Middle Aged, Obesity, Morbid, Postoperative Complications, Preoperative Care, Retrospective Studies, Gastric Bypass, Comorbidity, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
