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Comprehensive preoperative evaluations and individualised treatment plans reduced post-surgical ICU

Researchers from the King Hamad Univeristy Hospital, Muharraq, Bahrain, have reported much lower rate of intensive care unit (ICU) admissions after bariatric surgery compared to previous studies. According to the researchers, the findings highlight the need for comprehensive preoperative evaluations and individualised treatment plans to optimise the safety and success of bariatric surgery.

The authors noted that as the number of patients undergoing bariatric surgery is increasing, there has also been an increase in revisional surgeries. Several reasons can prompt a revision of bariatric surgery, including weight gain, insufficient weight loss or surgical complications. The incidence of revisional procedures after primary bariatric surgery is dependent on the primary bariatric procedure. They stated that the incidence of revision procedures is estimated at 29%-39% in vertical banded gastroplasty, 10.5% and 60% for adjustable gastric banding and 15% to 35% for gastric bypass.


However, several studies have demonstrated postsurgical complications following bariatric surgery that require ICU admission. The complications can be categorized into two groups; early complications (<10 days) and late complications (>10 days). Early onset of complications include surgical wound infections, anastomosis dehiscence, fistulas, haemorrhage, venous thromboembolism, and incisional hernias. The incidence of postoperative complications includes haemorrhage, thromboembolism and operational wound problems. The decision to admit patients to the ICU after bariatric surgery is controversial, with the majority of the decisions being made based on the surgeon’s experience. However, most researchers advocate the avoidance of ICU hospitalisation to reduce costs and length of hospital stay.


However, despite the significant amount of research across the globe, there is a lack of data from the Middle East and North Africa region. Therefore, they undertook this retrospective study to assess the incidence of ICU admission following bariatric surgery at King Hamad University Hospital, Bahrain.


This study included 775 patients who underwent bariatric surgery between 2018 and 2020. The study also included patients who required ICU admission after the surgical procedure. The primary outcome of the study was to identify the incidence of ICU admission following bariatric surgery and ICU mortality in admitted patients. The secondary outcomes included risk factors for ICU admissions, the number of days of ICU admission, and medical complications that led to admission to the ICU.


Outcomes

A majority of the 775 patients were female (66.3%, n=514). The BMI of patients was divided into four categories: the highest number of patients (26.8%, n=208) had a BMI between 40-44.9kg/m2, followed by ≥50kg/m2 (21.5%, n=167), 45-49.9kg/m2 (21.3%, n=165) and a total of 97.3% (n=754) of patients had a BMI above 30kg/m2. Regarding comorbidities, 50.58% (n=392) of patients were suffering from hypertension and 26.45% (n=205) from diabetes.

The majority of the participants underwent laparoscopic sleeve gastrectomy (75%, n=564), followed by gastric bypass surgery (22.6%, n=170), sleeve gastrectomy and laparoscopic cholecystectomy (1.9%, n=14), and gastric bypass plus laparoscopic cholecystectomy (0.5%, n=4). Overall, 91.3% (n = 21) of patients underwent conversion from sleeve gastrectomy to gastric bypass, whereas 8.7% (n = 2) of patients underwent a revision of classic gastric bypass.


Overall, 752 (97%) procedures were primary bariatric surgery and 23 (3%) were revisional bariatric surgery. The majority of the procedures were conducted in 2018, with primary (99.7%, n=299) and revision (0.3%, n=1). In 2019, all procedures were primary whereas in 2020, 91.1% (n=224) of bariatric procedures were primary.


In 2018, only one (0.13%) patient was admitted to the ICU after the surgery. In 2020, five (0.64%) patients had ICU admission after bariatric surgery, an overall total of 0.77%. ICU-related mortality occurred in two (0.26%) patients. Of the six patients, three underwent primary bariatric surgery and three underwent revision surgery. The number of ICU days ranged from 1 to 54 days. In the present study, sepsis and septic shock were the most common reasons for ICU admission. The most common reason for sepsis is anastomotic leak which leaks into the abdominal cavity, resulting in peritonitis and sepsis. In the present study, only one out of six ICU-admitted patients developed respiratory complications. ICU-related mortality was observed in two out of six patients, representing a mortality rate of 0.33%.


The findings were reported in the paper, ‘Patient Outcomes and Rate of Intensive Care Unit Admissions Following Bariatric Surgery: A Retrospective Cohort Study of 775 Patients’, published in Cureus. To access this paper, please click here

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