Risk factors for acute respiratory failure in bariatric surgery: data from the Nationwide Inpatient Sample, 2006-2008.
ABSTRACT BACKGROUND: Acute respiratory failure (ARF) can be a life-threatening postoperative complication after bariatric surgery and is defined as the presence of acute respiratory distress or pulmonary insufficiency. We sought to identify predictors of ARF in patients who underwent bariatric surgery. METHODS: Using the Nationwide Inpatient Sample database, from 2006 to 2008, the clinical data from morbidly obese patients who underwent bariatric surgery were examined. Multivariate regression analysis was performed to identify the independent factors predictive of ARF. The factors examined included patient characteristics, co-morbidities, payer type, teaching status of hospital, surgical techniques (laparoscopic versus open), and type of bariatric operation (gastric bypass versus nongastric bypass). RESULTS: A total of 304,515 patients underwent bariatric surgery during the 3-year period. The overall ARF rate was 1.35%. The greatest rate of ARF (4.10%) was observed after open gastric bypass surgery. The ARF rate was lower after laparoscopic than after the open surgical technique (.94% versus 3.87%, respectively; P < .01) and after nongastric bypass versus gastric bypass (.82% versus 1.54%, respectively; P < .01). Using multivariate regression analysis, congestive heart failure (adjusted odds ratio [AOR] 5.1), open surgery (AOR 3.3), chronic renal failure (AOR 2.9), gastric bypass (AOR 2.5), peripheral vascular disease (AOR 2.4), male gender (AOR 1.9), age >50 years (AOR 1.8), Medicare payer (AOR 1.8), alcohol abuse (AOR 1.8), chronic lung disease (AOR 1.6), diabetes mellitus (AOR 1.2), and smoking (AOR 1.1) were factors associated with greater rates of ARF. Compared with patients without ARF, patients with ARF had significantly greater in-hospital mortality (5.69% versus .04%, P < .01). CONCLUSION: We identified multiple risk factors that have an effect on the development of acute respiratory failure after bariatric surgery. Surgeons should consider these factors in surgical decision-making and inform patients of their risk of this potentially life-threatening complication.
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ABSTRACT: Bariatric surgery is an effective long-term treatment for morbid obesity. Although smoking is known to increase postoperative complications, the independent effect of smoking on bariatric surgical outcomes is unclear. The purpose of this study was to investigate the effect of smoking on bariatric surgical outcomes using the National Surgical Quality Improvement Program (NSQIP). Bariatric patients from 2005 to 2010 were identified in NSQIP for all types of bariatric procedures except adjustable gastric banding. Pre-treatment variables' univariate associations with smoking were examined with chi-square and t tests. Association of smoking with outcomes, corrected for relevant covariates, was tested with logistic regression within laparoscopic and open treatment groups. A total of 41,445 patients underwent bariatric surgery (35,696 laparoscopic; 5,749 open). After controlling for covariates, smoking significantly increased the risk of organ space infection, prolonged intubation, reintubation, pneumonia, sepsis, shock, and longer length of stay in all patients undergoing bariatric surgery. In the open bariatric surgery subgroup, smoking was associated with a significantly higher incidence of organ space infection, prolonged intubation, pneumonia, and length of stay. In the laparoscopic surgery subgroup, smokers had a significantly increased incidence of prolonged intubation, reintubation, sepsis, shock, and length of stay. Smoking did not significantly increase the risk of mortality for patients undergoing bariatric surgery. These data suggest that smoking is a modifiable preoperative risk factor that significantly increases the incidence of postoperative morbidity but not mortality in both laparoscopic and open bariatric surgery. Smoking cessation may minimize the risk of adverse outcomes. Future investigation is needed to identify the optimal length of preoperative smoking cessation.Surgical Endoscopy 06/2014; 28(11). DOI:10.1007/s00464-014-3581-z · 3.31 Impact Factor
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ABSTRACT: Postoperative pulmonary complications (PPC) in bariatric surgery have not been well studied. Additionally, many bariatric patients suffer from the metabolic syndrome (MetS), contributing to surgical risk. We examined the incidence of PPC and MetS in a large national bariatric database. Furthermore, we analysed the relationships between morbidity, mortality, PPC, MetS, and several other comorbidities and also surgical factors.BJA British Journal of Anaesthesia 10/2014; DOI:10.1093/bja/aeu362 · 4.35 Impact Factor
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ABSTRACT: Background. Potassium-channels in the carotid body and the brainstem are important regulators of ventilation. The BKCa-channel contains response elements for CO, O-2, and CO2. Its block increases carotid body signalling, phrenic nerve activity, and respiratory drive. GAL-021, a new BKCa-channel blocker, increases minute ventilation in rats and non-human primates. This study assessed the single-dose safety, tolerability, pharmacokinetics (PKs), and pharmacodynamics (PDs) of GAL-021 in healthy volunteers. Methods. Thirty subjects participated in a nine-period, randomized, double-blinded, placebocontrolled, crossover, ascending dose, first-in-human study with i.v. infusions of 0.1 -0.96 mg kg(-1) h(-1) for 1 h and intermediate doses up to 4 h. Results. Adverse event rates were generally similar among dose levels and between placeboand GAL-021-treated subjects. At higher GAL-021 doses, a mild/moderate burning sensation at the infusion site occurred during the infusion. No clinically significant changes in vital signs or clinical chemistries were noted. Minute ventilation increased (AUE(0-1 h) approximate to 16%, P<0.05) and end-tidal carbon dioxide (E'(CO2))) decreased (AUE(0-1 h) approximate to 6%, P<0.05) during the first hour at 0.96 mg kg(-1) h(-1) with 1/2-maximal V(over dot)(E) and E'(CO2)-change occurring by 7.5 min. Drug concentration rose rapidly during the infusion and decreased rapidly initially (distribution t(1/2) of 30 min) and then more slowly (terminal tin of 5.6 h). Conclusions. GAL-021 was safe and generally well tolerated with adverse events comparable with placebo except for an infusion site burning sensation. GAL-021 stimulated ventilation at the highest doses suggesting that greater infusion rates may be required for maximum PD effects. GAL-021 had PK characteristics consistent with an acute care medication.BJA British Journal of Anaesthesia 07/2014; 113(5). DOI:10.1093/bja/aeu182 · 4.35 Impact Factor