The association of pre-operative STOP-BANG scores with postoperative critical care admission

The STOP-BANG questionnaire screens for obstructive sleep apnoea. We retrospectively analysed the independent association of pre-operative variables with postoperative critical care admission using multivariable logistic regression for patients undergoing elective surgery from January to December 2011. Of 5432 patients, 338 (6.2%) were admitted postoperatively to the critical care unit. In multivariate analysis, the odds ratios (95% CI) for critical care admission were: 2.2 (1.1-4.6), p = 0.037; 3.2 (1.2-8.1), p = 0.017; and 5.1 (1.8-14.9), p = 0.002, for STOP-BANG scores of 4, 5 and ≥ 6, respectively. The odds ratio was also independently increased for: each year of age, 1.015 (1.004-1.026), p = 0.019; asthma, 1.6 (1.1-2.4), p = 0.016; obstructive sleep apnoea, 3.2 (1.9-5.6), p < 0.001; and for ASA physical status 2, 3 and ≥ 4, 2.1 (1.4-3.3), 6.5 (3.9-11.0), 6.3 (2.9-13.8), respectively, p < 0.001 for all.

Perioperative risk factors in obese patients for bariatric surgery: a Singapore experience

INTRODUCTION

Morbid obesity and obstructive sleep apnoea (OSA) are increasingly encountered in anaesthetic practice today. Difficult intubation may be seen more frequently in our practice. This high-risk group may also be more prone to complications in the postoperative period.

METHODS

We reviewed a consecutive series of patients who had undergone laparoscopic gastric banding at our institution from 2001 to 2006. The incidence of difficult intubation, early postoperative complications and its attendant risk factors were studied.

RESULTS

Severe OSA and neck circumference greater than 44 cm were factors associated with difficult intubation in morbidly obese patients who presented for bariatric surgery. Asthma and increasing age may be associated risk factors for adverse events in the postoperative period.

CONCLUSION

It is important to anticipate and prepare for a difficult intubation scenario in patients with severe OSA and a larger neck circumference. Close monitoring is recommended for patients with respiratory comorbidities and advanced age.