Use of critical care resources after laparoscopic gastric bypass: effect on respiratory complications

Background: Before 2005, all subjects undergoing laparoscopic gastric bypass with a body mass index >50 kg/m(2), age >40 years, and documented obstructive sleep apnea (OSA) were admitted to the intensive care unit (ICU) in our institution. Starting in January 2005, only patients with a body mass index >60 kg/m(2) and severe OSA were admitted. This study assessed the incidence of respiratory complications in patients undergoing laparoscopic gastric bypass before and after implementation of the new ICU admission criteria. Methods: The records of the laparoscopic gastric bypass patients who had undergone laparoscopic gastric bypass from January 2004 to December 2005 were reviewed regarding demographic data (age, sex, body mass index, American Society of Anesthesiologists classification); OSA; use of home continuous positive airway pressure; length of stay in postanesthesia care unit, ICU, and hospital; postoperative ventilation and hypoxemia (oxygen saturation <90%), and unplanned ICU admission. Results: A total of 250 charts were analyzed (122 frorn 2004 and 128 from 2005). The demoaraphic data were comparable between the 2 groups. Although OSA was more frequent in the 2004 than in the 2005 cohort (P =.02), the incidence of OSA requiring home continuous positive airway pressure was comparable (P =.47). The length of hospital stay was greater in 2004 than in 2005 (P =.003). More patients were admitted to the ICU in 2004 (P <.001). All unplanned ICU admissions were because of surgical anastomotic/staple line leaks (7 patients in 2004 versus 0 in 2005 P =.006). Overall, the incidence of postoperative respiratory complications was low (6% in 2004 and 4% in 2005) and comparable in both groups. Conclusion: Limiting ICU admission after laparoscopic gastric bypass to patients with a body mass index >60 kg/m(2) and severe OSA did not increase the overall incidence of postoperative respiratory complications or hospital stay. (Surg Obes Relat Dis 2008;4:698-703.) (C) 2008 American Society for Metabolic and Bariatric Surgery. All rights reserved.