The anaesthetic assessment, management and risk factors of bariatric surgical patients requiring postoperative intensive care support: a state-wide, five-year cohort study

摘要

Bariatric surgery is a rapidly growing and dynamic discipline necessitating a specialised anaesthetic approach coordinating high-risk patients with appropriate postoperative intensive care (ICU) support. The relationship between the anaesthetic and ICU utilisation after bariatric surgery is poorly understood. All adult bariatric surgery patients admitted to any ICU over a five-year period between 2007 and 2011 in Western Australia were identified from hospital admission records and cross-referenced against the Western Australian Department of Health Data Linkage Unit database. During the study period 12,062 patients underwent bariatric surgery with 581 (4.8%) patients admitted to ICU immediately following surgery. The mean preoperative ASA score was 3.3 (standard deviation 1.1) with 76.9% of patients assessed by their anaesthetist for the first time on the day of surgery. Blood pathology (75%) and ECG (46.3%) were the most common preoperative investigations. Intraoperatively, 2.1% of patients had a grade 4 intubation with only 3.4% of patients requiring video-assisted intubation. Despite being deemed at high risk, 23.6% of patients were managed with 20 Gauge or smaller intravenous access. Anaesthetic complications were extremely uncommon (0.5% of all bariatric cases) but accounted for 9.7% of all postoperative ICU admissions. Smoking history, but not body mass index (P=0.46), was the only significant prognostic factor for respiratory or airway-related anaesthetic complications (P=0.012). In summary, the anaesthesia management of bariatric surgery varied widely in Western Australia, with smoking as the only significant preoperative risk factor for respiratory or airway-related anaesthesia complications.