Effects of CPAP on gastric pouch pressure after bariatric surgery

The effect of postoperative CPAP use on anastomotic and staple line leakage after bariatric surgery

PURPOSE

Almost two-thirds of the population undergoing bariatric surgery (BS) suffers from obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) is the standard treatment for moderate to severe OSA and is recommended in patients undergoing BS perioperatively. A severe and dreaded complication after BS is anastomotic leakage. There is theoretical concern that perioperative CPAP use may result in increased distension of the gastrointestinal tract and increase the risk of developing an anastomotic leakage. The aim of this study was to evaluate the effect of postoperative CPAP use on the risk of developing anastomotic leakages after BS.

METHODS

Retrospectively, all patients from a single bariatric center who underwent BS from November 2007 to August 2019 were included. Presence and severity of OSA were determined using poly(somno)graphy. To evaluate the effect of postoperative CPAP use on anastomotic leakage, a multivariable logistic regression analysis was performed.

RESULTS

A total of 4052 patients were included, with OSA being diagnosed in 62%. Overall, 970 patients (24%) used CPAP after BS. Anastomotic leakage occurred in 64 (1.6%) patients after BS. Leakage rate was 1.3% in non-CPAP group versus 2.5% in CPAP group (p = 0.01). CPAP use was associated with anastomotic leakage; however, after adjustment, CPAP use was not an independent predictor (OR = 1.40, 95% CI 0.60-3.28, p = 0.44).

CONCLUSION

There is no independent relation between postoperative CPAP use and anastomotic leakage after BS. Only revision surgery was an independent predictor of anastomotic leakage.

Sleep-disordered breathing and postoperative outcomes after bariatric surgery: analysis of the nationwide inpatient sample

BACKGROUND

Sleep-disordered breathing (SDB), also known as obstructive sleep apnea (OSA), has been increasingly recognized as a possible risk factor for adverse perioperative outcomes in non-bariatric surgeries. However, the impact of SDB on postoperative outcomes in patients undergoing bariatric surgery remains less clearly defined. We hypothesized that SDB would be independently associated with worse postoperative outcomes.

METHODS

Data were obtained from the Nationwide Inpatient Sample database and included a total of 91,028 adult patients undergoing bariatric surgeries from 2004 to 2008. The primary outcomes were in-hospital death, total charges, and length of stay. There were two secondary outcomes of interest: respiratory and cardiac complications. Regression models were fitted to assess the independent association between SDB and the outcomes of interest.

RESULTS

SDB was independently associated with decreased mortality (OR = 0.34, 95% CI = 0.23-0.50, p < 0.001), total charges (-$869, p < 0.001), and length of stay (-0.25 days, p < 0.001). SDB was independently associated with significantly increased odds ratio of emergent endotracheal intubation (OR = 4.35, 95% CI = 3.97-4.77, p < 0.001), noninvasive ventilation (OR = 14.12, 95% CI = 12.09-16.51, p < 0.001), and atrial fibrillation (OR = 1.25, 95% CI = 1.11-1.41, p < 0.001). Emergent intubation occurred significantly earlier in the postoperative course in patients with SDB. Although non-SDB patients had an overall lower risk of emergent intubation compared to SDB patients, their outcomes were significantly worse when they did get emergently intubated.

CONCLUSIONS

In this large nationally representative sample, despite the increased association of SDB/OSA with postoperative cardiopulmonary complications, the diagnosis of SDB/OSA was negatively, rather than positively, associated with in-hospital mortality and resource use.